Assessment of Quality of Palliative Care in Patients with Chronic Diseases

Abstract

Abstract Background and objectives: Palliative care focuses on the physical, mental, social, and spiritual needs of patients with chronic disease to improve their quality of life. The present study aimed to assess the quality of palliative care in patients with chronic diseases in two hospitals in Gorgan, Iran. Method This explanatory sequential study with a mixed methods design was carried out in two quantitative and qualitative phases. In the quantitative phase, a descriptive study was carried out to collect data using the Persian version of the Quality of Palliative Care from the Patient's Perspective questionnaire. By proportional allocation of subjects and using stratified sampling, 201 patients with chronic diseases who had been admitted to hospitals affiliated with the Golestan University of Medical Sciences were enrolled. Data were described in SPSS16 using central tendency and dispersion indices. Using conventional content analysis, patients whose mean scores on the palliative care quality in the quantitative phase were within ± 1 standard deviation of the total mean score were enrolled in the qualitative phase. Then, semi-structured in-depth interviews were conducted until data saturation. The collected data were analyzed using Graneheim and Lundman's approach. Finally, the results of the two phases were combined in the discussion section. Results According to the results of the quantitative phase, favorable scores were given by the patients to the subscales of availability of caregivers (mean score of 0.90 out of 1), provision of care information and patient’s involvement in decision making (0.83 out of 1), pain management (0.86 out of 1), caregiver’s listening skill (0.76 out of 1), and serenity (0.70 out of 1). In addition, relatively favorable scores were given to the subscale of respect for the patients (0.47 out of 1). However, unfavorable scores were given for the psychosocial and spiritual dimensions (0.52 out of 1). The total mean score of palliative care quality was favorable (0.61 out of 1). The qualitative findings suggested six main categories: access to care information, patient involvement in decision making, support, safe care, pain management, and respect. Conclusion Mixing quantitative and qualitative data creates a better picture of the issue of palliative care quality. Our results could be used by healthcare managers in the study area to ultimately promote the quality of palliative care in patients with chronic diseases by addressing their physical, mental, social, and spiritual needs.