A comparison of service and non-service determinants of carers' satisfaction with palliative care services
The association between carers' satisfaction with services delivered by district nurses (DNs), general practitioners (GPs), hospital doctors (HDs), and the health and social services in general (HSS), and various service and non-service variables was examined to assess whether satisfaction is more a reflection of the service characteristics, the non-service related factors, or attributable equally to both. Analysis was undertaken on a sub-sample of the 'Regional Study of Care for the Dying', a retrospective survey assessing the perceptions of 3696 carers of services delivered to deceased in their last year of life. The sub-sample consisted of 1858 carers of deceased who were relatives or close friends/neighbours, whose deceased died from cancer, and whose death was not sudden. Satisfaction variables were derived from questions recorded in the survey. In bivariate and multivariate analysis, larger odds ratio were found in association with service than non-service variables. For example, high satisfaction with DNs was strongly associated with visiting the patient very frequently (OR= 10.8, 95% CI= 4.5-25.9); and the GP visiting 20 times or more (OR= 5.5, 95% CI= 3.6-8.5), and informing the carer of the diagnosis (0R= 3.3, 95% CI= 2.3-4.7) were associated with high satisfaction with GPs. Examples of non-service factor associations included, for example, good postbereavement psychological state positively associated with high satisfaction with DNs (OR 2.3, 95% CI= 1.6-3.4) and GPs (OR= 2.0, 95% CI= 1.4-2.8); while perceiving caring as rewarding as opposed to a burden was positively associated with high satisfaction with DNs (OR= 3.7, 95% CI= 1.8-7.5) and negatively associated with high satisfaction with hospital doctors (OR= 0.46, 95% CI= 0.24- 0.86). The fmdings reflect, in part, the literature on satisfaction in other areas of health care, but there are some differences, for example sociodemographic variables such as age, sex, religious denomination, and housing tenure were found to have no role in predicting satisfaction with DNs, GPs, and HDs. In post-bereavement surveys evaluating palliative care, carers' satisfaction reflects service characteristics but it is also partly determined by important patient and carer characteristics.