Perceived Quality of Care: A Comparison Between a Previous Non-Palliative Hospital Admission and Admission to an Acute Palliative Care Unit. A Mixed-Methods Observational Study.

BackgroundPatient satisfaction complements clinical outcomes, but few studies compare, within the same patient, a previous non-palliative admission with a subsequent admission to an acute palliative care unit (APCU).MethodsSingle-centre, observational, mixed-methods, within-subject study with prospective enrolment. All patients admitted to a hospital-based APCU were screened; eligible patients had a previous admission elsewhere within the preceding month. The primary outcome was overall satisfaction; other outcomes were exploratory.ResultsOf 374 consecutive admissions (316 patients) screened, 38 patients completed data collection. Length of stay did not differ significantly (P = 0.736). Overall satisfaction was higher for the APCU admission (median 4 [IQR 4-5] vs 4 [2.25-4]; P = 0.0005, Holm-adjusted P = 0.005). In exploratory, unadjusted analyses, participants also reported greater ability to share personal worries (P = 0.021) and clearer answers (P = 0.013). The same proportion of participants reported at least one unsatisfactory aspect (57.9% for both admissions), but its content shifted from relational/environmental to mainly organisational issues - timeliness of nursing assistance and food - while staff courtesy was mentioned more often for the APCU (11 vs 2 patients).ConclusionsParticipants reported more favourable experiences on selected measures, most consistently overall satisfaction, during their APCU admission than during their most recent non-palliative admission. Residual concerns related mainly to timeliness of assistance and food, which overlap with relational aspects of care. The reasons for these differences require further investigation in larger, multi-centre studies.