Differing Perceptions of End-of-Life Care in Long-Term Care

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Abstract
BACKGROUND: Care team members may have different views on end-of-life care, which may influence perceptions of that care. METHODS: Twenty-seven consecutive deaths at a long-term care facility were identified. A structured interview of primary care team members (physician, nurse, and aide) was administered. The interview asked comparable questions to each group on a Likert scale (1 = least satisfied; 4 = most satisfied) regarding the resident's experience in the last 3 days of life. Areas assessed were pain, comfort, emotional support, adequacy of information provided to families, whether direct care needs were met, supportive care, time spent with resident, number of symptoms present at the end of life, and quality of death. Repeated measures analysis of variance was used to determine if the mean values of various response measures differed significantly by rater group (i.e., physicians, nurses, or aides). RESULTS: Aides perceived more resident pain compared to physicians or nurses. Physicians' perceptions of emotional support provided to families were lower than those of aides or nurses. CONCLUSIONS: This study demonstrates differing perceptions by care team members regarding end-of-life care. Areas of difference include pain and emotional support provided to families. Because effective team functioning requires understanding and recognition of different perceptions of team members, clarifying and addressing the reasons for these differences may improve both job satisfaction on the part of care team members, as well as the quality of end-of-life care delivered.

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