Variations in Care Quality Outcomes of Dying People: Latent Class Analysis of an Adult National Register Population

Joakim Öhlén, Lara Russell, Cecilia Håkanson, Anette Alvariza, Carl Johan Fürst, Kristofer Årestedt, Richard Sawatzky

Symptom relief is a key goal of palliative care. There is a need to consider complexities in symptom relief patterns for groups of people in order to understand and evaluate symptom relief as an indicator of quality of care at end of life. The aims of this study were to distinguish classes of patients who have different symptom relief patterns during the last week of life and to identify predictors of these classes in an adult register population. In a cross-sectional retrospective design, data was used from 87,026 decedents with expected deaths registered in the Swedish Register of Palliative Care in 2011 and 2012. Study variables were structured into patient characteristics, and processes and outcomes of quality of care. A latent class analysis was used to identify symptom relief patterns. Multivariate multinomial regression analyses were used to identify predictors of class membership. Five latent classes were generated: "relieved pain", "relieved pain and rattles", "relieved pain and anxiety", "partly relieved shortness of breath, rattles and anxiety" and "partly relieved pain, anxiety and confusion". Important predictors of class membership were age, sex, cause of death, and having someone present at death, individual PRN prescriptions and expert consultations. Inter-individual variability and complexity in symptom relief patterns may inform quality of care and its evaluation for dying people across care settings.