Quality of outpatient palliative care assessed by direct service providers, regional palliative care organisations and healthcare authorities – A nationwide survey from Switzerland

Abstract

Purpose

A prior study used 13 indicators to assess overall palliative care quality: Switzerland scored 88 points (top quartile: 82–93). This study assessed the quality of outpatient palliative care in Switzerland, and identified criteria associated with higher quality.

Method

Cross-sectional study surveying direct service providers, 14 palliative care organisations, 26 healthcare authorities. The 13 indicators assessed outpatient palliative care quality. Multivariable regression analysed associations between established criteria and higher scores.

Results

The survey was completed by 141 participants (≥4 per canton) including 96 (68%) direct service providers, all palliative care organisations and cantonal authorities. Nurses accounted for 52% (n = 73, including 61 providers). Participants agreed with ‘treated kindly’ (98% agreed), ‘controlled pain and discomfort’ (98%), ‘appropriate levels of life extending treatments’ (95%) but disagreed with ‘costs are no barrier’ (44% disagreed), ‘good coordination’ (19%), ‘cared for/die at place of choice’ (14%). All 13 indicator questions were answered by 100 participants (71%), resulting in a median score of 82. Of participants seeing patients, 85% (82/97) answered all 13 questions, only 41% (18/44) of those without patient contact (p < 0.001). ‘Recording desired place of death’ (odds ratio [OR] 6.7, 95% confidence interval [95%CI] 2.7–21.3), ‘preventing critical incidents’ (OR 5.8, 95%CI 2.8–13.0), ‘recording critical incidents’ (OR 2.1, 95%CI 1.3–3.7) were independently associated with higher scores.

Conclusions

A score of 82 indicates high quality. Recording desired place of death, preventing critical incidents, costs, and coordination require attention. Only those with patient contact are best suited to assess the quality of outpatient palliative care.