The study investigated the quality of end-of-life care in hospitals settings and the utility of bereaved relatives' views for improving care. It was conducted over ten years utilizing a multi-phased mixed methods design. In Ireland, 30,000 people die each year. Two thirds die in hospital settings. Yet prior to the initiation of this study in 2007, there was little research examining bereaved relatives' perspectives of the quality of end-of-life care in hospital settings. There was a gap in the

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... esearch comparing quality between acute and community hospitals. The first phase of the study (Part A) began in 2007. It compared the quality of end-of-life care, rated retrospectively by bereaved relatives, between two acute and two community hospitals. It examined the importance of hospital type (acute versus community) in comparison to patient and family factors, in influencing bereaved relatives' perception of two outcomes measures (a) unmet needs for specific domains of end-of-life care and (b) satisfaction with care. The study design formed a cross sectional retrospective postal survey. Of 374 relatives contacted, 142 opted to consent to receive the questionnaire. Then 118 (Acute Hospitals =50, Community Hospitals = 68) relatives returned questionnaires. The study response rate was 31.6%. The Part A survey formed part of the early work of the Hospice Friendly Hospitals (HFH) Programme. This was a nationwide initiative, implemented over three phases between 2007 and 2015, concerned with improving the quality of end-of-life care for patients and their families. As the HFH Programme progressed there was an observed shift in approaches to measuring quality of end-of-life care. In addition to research approaches, bereaved relatives' views were now being collated using quality improvement and assurance approaches. Yet no reflective account existed of the pragmatic value of collating their views for making improvements in care, nor of the relative utility of the different paradigms outlined. Therefore in 2014, the second ph [...]