Invitations for free-text comments on surveys provide family members of hospice patients an opportunity to “tell” their story of the hospice experience and caregiver relationships during the last months of life. These comments are a rich source of data for understanding the complex interpersonal relationships that influence patient/family perceptions of both quality of care and quality of life. Analysis of 438 free-text comments provided by 243 hospice family members revealed 5 emergent caregiver relationship themes: knowledge, skills, and abilities; empathy and compassion; trust and acceptance; communication experience and time spent with caregiver. Findings support the value of free-text comments to explain or add depth to quality assessments, modify therapeutic interventions, and identify strategies for process improvement that advance hospice quality of care.
TenoJMClarridgeBRCaseyV. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):888–893.
2.
SteinhauserKEChristakisNAClippECMcNeillyMMcIntyreLTulskyJA.Factors considered important at the end of life by patients, family physicians, and other care providers. JAMA. 2000;284(19):2476–2482.
3.
HiattKStelleCMulsowMScottJP.The importance of perspective: evaluation of hospice care from multiple stakeholders. Am J Hosp Palliative Med. 2007;24(5):376–382.
4.
LukerKAAustinLCaressAHallettCE.The importance of ‘knowing the patient’: community nurses constructions of quality in providing palliative care. J Adv Nurs. 2000;31(4):775–782.
5.
RhodesRLMitchellSLMillerSCConnorSRTenoJM.Bereaved family members’ evaluation of hospice care: what factors influence overall satisfaction with services?J Pain Symptom Manage. 2008;35(4):365–371.
6.
ReissmanJC.Narrative Analysis. Vol 30.:Newbury Park CA: Sage; 1993.
7.
GubriumJFHolsteinJA, Eds. Handbook of Interview Research. Newbury Park CA: Sage; 2002.
8.
BrunnerJS.Acts of Meaning. Cambridge, MA: Harvard University Press; 1990.
9.
GeeJ.The Narrativization of experience in the oral style. J Educ. 1985;167(1):9–35.
10.
McPhersonCJAddington-HallJM.Judging the quality of care at the end of life: can proxies provide reliable information?Soc Sci Med. 2003;56(1):95–109.
11.
GarciaJEvansJReshawM.“Is there anything else you would like to tell us”—methodological issues in the use of free-text comments from postal surveys. Quality Quantity. 2004;38(2):113–125.
12.
MaliskiSLLitwinMS.Unsolicited written comments: an untapped data source. Oncol Nurs Forum. 2007;34(1):142–147.
13.
MilesMBHubermanAM.Qualitative Data Analysis.2nd ed. Thousand Oaks, CA: Sage, 1994:1, 55.
14.
HeskettJLJonesTOLovemanGWSasserWE,Jr., Schlesinger L. Putting the service-profit chain to work. Harvard Business Rev. 1994;72(2):164–174.
15.
HeskettJLSasserWESchlesingerL.The Service Profit Chain. New York, NY: The Free Press; 1997.
16.
ReichheldFF.The Loyalty Effect: The Hidden Force Behind Growth, Profits, and Lasting Value. Boston, MA: Harvard Business School Press; 1996.
17.
ArthurJB.Effects of human resource systems on manufacturing performance and turnover. Acad Manag J. 1994;37(5):672–687.
18.
CookLSVermaR.Exploring the linkages between quality system service quality and performance excellence: service providers’ perspectives. Quality Manag J. 2002;9(2):45–56.
19.
EvansJRJackEP.Validating key results linkages in the Baldrige performance excellence model. Quality Manag J. 2003;10(2):7–24.
20.
HuselidMAJacksonSESchulerRS.Technical and strategic human resource management effectiveness as determinants of firm performance. Acad Managt J. 1997;40(3):171–188.
21.
KoysDJ.The effects of employee satisfaction, organizational citizenship behavior, and turnover on organizational effectiveness: a unit level longitudinal Study. Personnel Psychol. 2001;54(1):101–114.
22.
RucciAJKimSPQuinnRT.The employee customer profit chain at Sears. Harvard Business Rev. 1998;76(1):83–97.
23.
GriffithJRWhiteKR.The revolution in hospital management. J Healthcare Manag. 2005;50(3):170–189.
HarmonJScottiDJBehsonSFariasGPetzelRKeashlyL.Effects of high-involvement work systems on employee satisfaction and service costs in veterans’ healthcare. J Health Care Manag. 2003;48(6):393–406.
26.
RaveNGeyerMReederBErnstJGoldbergLBarnardC.Radical systems change. Innovative strategies to improve patient satisfaction. J Ambulatory Care Manag. 2003;26(2):159–174.
27.
WilliamsESSkinnerAC.Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research. Health Care Manag Rev. 2003;28(2):119–139.
28.
HaasJSCookEFPuopoloALBurstinHRClearyPDBrennanTA.Is the professional satisfaction of general internists associated with patient satisfaction?J General Internal Med. 2000;15(2):122–128.
29.
NewmanKMaylorU.Empirical evidence for nurse satisfaction, quality of care and patient satisfaction chain. Int J Health Care Quality Assurance. 2002;15(2):80–88.
30.
BuchbinderSBWilsonMMelickCFPoweNR.Primary care physician job satisfaction and turnover. Am J Manag Care. 2001;7(7):701–713.
31.
IngersollGLOlsanTDrew-CatesJDeVinneyBCDaviesJ.Nurse’s satisfaction, organizational commitment, and career intent. J Nurs Admin. 2002;32(5):250–263.
32.
AtkinsPMMarshallBSRajshekharGJ.Happy employees lead to loyal patients. J Health Care Market. 1996;16(4):14–23.
33.
RadwinLE.“Knowing the patient”: a review of research on an emerging concept. J Adv Nurs. 1996;23(6):1142–1146.
34.
MountBM.Hospice care. J Royal Soc Med. 1980;73(7):471–473.
35.
McGlynnEA.Six challenges in measuring the quality of health care. Health Affairs. 1997;16(3):7–21.
36.
JohnstonBSmithLN.Nurses’ and patients’ perceptions of expert palliative nursing care. J Adv Nurs. 2006;54(6):700–709.
37.
RaudonisBM.The meaning and impact of empathic relationships in hospice nursing. Cancer Nurs. 1993;16(4):304–309.
38.
StilesM.The shining stranger: nurse-family spiritual relationship. Cancer Nurs. 1990;13(4):235–245.
39.
YorkGSJonesJLChurchmanR.Understanding the association between employee satisfaction and Family perceptions of the quality of care in hospice service delivery. J Pain Symptom Manage. 2009;38(5):708–716.
40.
DonabedianA.The quality of care: how can it be assessed?JAMA. 1988;260(12):1743–1748.
41.
ConnorSRTenoJSpenceCSmithN.Family evaluation of hospice care: results from voluntary submission of data via website. J Pain Symptom Manag. 2005;30(1):4–17.
Baldrige National Quality Program, National Institute of Standards and Technology. Malcolm Baldrige health care criteria for performance excellence 2006. From Baldrige National Quality Program Web site: http://www.baldrige.nist.gov/HealthCare_Criteria.htm. Accessed December 28, 2010.
