Family Satisfaction and Bereavement Care following Death in the Hospital

We conducted telephone interviews to assess family satisfaction with end-of-life care in the hospital and to gauge the extent of bereavement follow-up. We interviewed 53 relatives or close companions of adults who had died in our hospital within 5 to 12 months, representing 51 of the 153 families of English-speaking patients who had experienced a nontraumatic, nonsudden hospital death over a 4-month period. Overall satisfaction with care and with communication was rated high on the Likert scale (mean 4.3, median 5 for both topics). However, we suggest that this commonly used quantitative evaluation method is inadequate for assessing family satisfaction with terminal care because simple, open-ended questions yielded an array of disturbing problems. We report on the major complaints of the bereaved, which primarily focused on respect for privacy, dignity, and comfort; communication with the family; emergency ward care; attention to advance directives; and bereavement support. We documented that commonly recommended bereavement services were lacking. Over a third of relatives reported no contact with hospital health professionals after the death, and over a quarter of contacts were patient-initiated. Most bereavement follow-up on the part of hospital staff seemed cursory or haphazard, rather than representing a serious and sustained attempt to assess or facilitate bereavement or identify a need for referral. Although 19% of respondents had sought professional help, none had been referred by their physician or the deceased's physician. Hospital-based social workers and chaplains played, at best, a minor role in bereavement follow-up.