Beyond emotional support: predictors of satisfaction and perceived care quality following the death of a baby during pregnancy

Objectives To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. Methods A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from >= 16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). Results Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. Conclusions The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.