Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives

Abstract

This ethnographic study draws on the experiences of members of interdisciplinary care teams working with end-of-life care patients to identify strategies to improve quality of life through care practices. We surveyed 133 staff and volunteers (physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators, and volunteers) who provide end-of-life care to patients in both home and institutional settings for 4 organizations in 2 counties in Upstate New York. Survey responses were analyzed using qualitative content analysis. The results identified numerous strategies to enhance and safeguard quality of life for end-of-life care patients and their family members. These strategies can be categorized into 6 domains: organization philosophy and mission; organizational policies; caregivers' behaviors and practices; symptom management; facility design, operation and management; and patient, family member, and caregiver experience. The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers, and support staff. When all of these strategies are used in harmony, care can truly be enhanced.

Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers

“…End-of-life (EoL) care, as part of palliative care, revolves around maintaining the quality of life of patients and their families, through comprehensive management of physical symptoms, psycho-social and spiritual difficulties. End-of-life care focuses on a short period of time before death [ 2 ] and includes discussion of medical practices (suspending or withholding specific cancer treatment and general care related to feeding, hydration, and resuscitation techniques; symptom management; euthanasia) and decision-making [ 3 , 4 ]. These decisions include p alliative sedation [ 5 ] and euthanasia.…”

Effectiveness of education based on family-centered empowerment model on health-promoting behaviors and some metabolic biomarkers in elderly women: A stratified randomized clinical trial

“…Evidence has shown that exercise, quitting smoking, limiting alcohol consumption, participating in learning activities, and integrating into society can help them to control many diseases and reduce their loss of functional capacity, which improves their quality of life and life expectancy. [ 22 ]…”

Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross‐Cultural Study to Elucidate the Dying Process

“…To date, many studies have explored aspects of QOD such as adequate symptoms control, facing and understanding death with an open mind, acceptance of death, honoring of autonomy and decision rights, preparation for passing away, to be seen as a whole person, meet the choice where they want to the end, and pass away during sleep, etc 17‐21 . Most studies investigating QOD among terminally ill patients with cancer were from the perspective of patients and families, and only a few studies evaluating the influence of medical treatments on the QOD suggested that appropriate management is essential to a good QOD 19,22 . Little is known about the relationship between AH use and QOD through cross‐cultural and multi‐national research.…”