Comfort goal of care and end-of-life outcomes in dementia: A prospective study.
BACKGROUND
Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome.


AIM
To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission.


DESIGN AND SETTING
Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in Dementia-Satisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14-42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician.


RESULTS
Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6 months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality of dying, no such association was found.


CONCLUSION
We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome.
['van Soest-Poortvliet|Mirjam C|MC|', 'van der Steen|Jenny T|JT|', 'de Vet|Henrica C W|HC|', 'Hertogh|Cees M P M|CM|', 'Deliens|Luc|L|', 'Onwuteaka-Philipsen|Bregje D|BD|']
D032722:Advance Care Planning D000368:Aged D000369:Aged, 80 and over D003704:Dementia D005190:Family D005260:Female D006040:Goals D017051:Hospice Care D006801:Humans D008134:Long-Term Care D008297:Male D009426:Netherlands D009735:Nursing Homes D010166:Palliative Care D017060:Patient Satisfaction D011446:Prospective Studies D011787:Quality of Health Care D011788:Quality of Life D012044:Regression Analysis D013727:Terminal Care
dementia nursing homes advance care planning Palliative care long-term-care