A Systematic Review of Satisfaction with Care at the End of Life

(See editorial comments by Dr. Jean S. Kutner, 160–162)

Authors

  • Sydney Morss Dy MD, MSc,

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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  • Lisa R. Shugarman PhD,

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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  • Karl A. Lorenz MD, MSHS,

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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  • Richard A. Mularski MD, MSHS,

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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  • Joanne Lynn MD, MA, MS,

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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  • for the RAND—Southern California Evidence-Based Practice Center

    1. From the Departments of *Health Policy and ManagementOncology, and Medicine, Johns Hopkins University, Baltimore, Maryland§Southern California Evidence-Based Practice Center and RAND Health, Santa Monica, CaliforniaVeterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California#Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
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Address correspondence to Sydney M. Dy, MD, MSc, Room 609, 624 North Broadway, Baltimore, MD 21205. E-mail: sdy@jhsph.edu

Abstract

The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients' decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A meta-analysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six showed a significant effect. For heart failure coordination of care, only seven of 32 studies addressed this as an outcome; two of the three that compared satisfaction between groups showed a significant difference. Evaluations used many different measures, only one of which was designed for the end of life. In conclusion, researchers have conceptualized satisfaction in palliative care, and different types of palliative care interventions can improve satisfaction, but it is often not included as an outcome. More focus on these satisfaction elements might improve the effectiveness of end-of-life interventions and their evaluation.

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