Perspectives of inpatients with palliative care needs, their families, clinicians and key stakeholders on measuring quality of hospital care via patient experience measures: A qualitative study

Abstract

Background: Globally there are high numbers of patients with palliative care needs receiving care in hospitals. Patient reported experience measures (PREMs) provide useful data to guide improvement work. How to implement PREMs within palliative care populations is unclear. Aim: To explore the perspectives of inpatients with palliative care needs, their family members, and the clinical team regarding the use of a generic PREM as compared with a PREM designed for people with palliative care needs and related implementation factors. Design: A qualitative study was undertaken using semi-structured interviews and focus groups and integrated thematic analysis. Setting/participants: Inpatients with palliative care needs, their family members, and clinical team members were recruited from three wards in an Australian metropolitan hospital. Results: Twenty-seven interviews and three focus groups were conducted. Six themes emerged: (1) PREMs for people with palliative care needs ought to be tailored to the needs of this population; (2) PREMs should appraise whether the needs of families have been met in addition to those of patients; (3) PREMs for inpatients with palliative care needs ought to be easy to use, brief and incorporate space for free text alongside each question; (4) Implementation of PREMs for people with palliative care needs ought to consider who administers these, when and how often; (5) PREM data need to be specific enough to inform process change and/or care provision; (6) Patients and families require meaningful feedback to encourage PREM completion. Conclusions: This study provides practical guidance for PREM selection and implementation to inform improvements to care for inpatients with palliative care needs.

Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM)

“…Patient Reported Experience Measures (PREMs) are one approach to measure experience to enable targeted improvements in quality inpatient palliative care [ 6 , 13 – 15 ]. PREMs differ to patient satisfaction measures, which measure how well a patient’s expectations were met [ 16 ] and patient-reported outcome measures (PROMS) which measure the health status and wellbeing of patients at a single time point [ 17 ] and can be used to improve communication and shared decision making between patients and health professionals [ 18 ].…”

“…PREMS are increasingly attracting attention as a health care quality indicator and can provide insight into how patient-centred existing services are, as well as identifying areas for improvements in healthcare delivery [ 21 ]. Providing clinical teams with robust PREM data, tailored to areas of care that matter most to people with palliative care needs has the potential to empower innovation and improvement, but uptake into clinical practice has been slow [ 13 , 19 ].…”

“…A recent qualitative study, led by members of this research team, asked inpatients with palliative care needs and their families about key requirements of a PREM to assess their experiences of hospital care [ 13 ]. Inpatients and their families noted the need for a PREM to be tailored to what matters most to the inpatient group, be brief, easy to use, and have space for free text responses [ 13 ]. Clinicians noted their need for data to be specific enough to inform practice or organisational changes [ 13 ].…”

“…Inpatients and their families noted the need for a PREM to be tailored to what matters most to the inpatient group, be brief, easy to use, and have space for free text responses [ 13 ]. Clinicians noted their need for data to be specific enough to inform practice or organisational changes [ 13 ]. Of all the PREMs designed for use with people with palliative care needs [ 6 ], consideRATE was the only one that meet these stated criteria.…”