Quality Improvement Activities in Japanese Palliative Care Units and Their Association with the Outcomes of a Post-bereavement Survey (J-HOPE4 Study)

Abstract

Objective: This study examined the relationship between the quality improvement activities in Japanese palliative care units and the bereavement outcomes of patients’ family members. Methods: From a post-bereavement survey (J-HOPE4) conducted in 2018, we sourced the data of 187 facilities. We summarized the quality improvement activities palliative care units performed and explored how these activities are associated with the bereavement outcomes of patients’ family members: overall satisfaction with the care provided, evaluation of the structure and process of care (Care Evaluation Scale: CES), perceived achievement of a good death (Good Death Inventory: GDI), grief (Brief Grief Questionnaire: BGQ), and depression (Patient Health Questionnaire 9: PHQ-9). Results: Facilities that participated in the self-evaluation program provided by Hospice Palliative Care Japan held multidisciplinary conferences more frequently and had more specialties positions attending conferences (all p<0.05) yielded greater overall satisfaction and perceived achievement of a good death. Facilities that provided bereavement care (all p<0.05) resulted in significantly higher overall satisfaction and favorable care evaluations. Grief was significantly lower when facilities made phone calls to bereaved families (p=0.03), and depression was significantly lower when facilities attended the funeral and wake services (p=0.02). Conclusion: Facilities that actively perform quality improvement activities may provide better palliative care and cause less grief and depression among bereaved family members.