The Society for Social Work and Research

2014 Annual Conference

January 15-19, 2014 I Grand Hyatt San Antonio I San Antonio, TX

Caregiver Evaluation of the Quality of End-of-Life Care (CEQUEL) Scale: The Caregiver's Perception of Patient Care Near Death

Saturday, January 18, 2014: 10:30 AM
HBG Convention Center, Room 003A River Level (San Antonio, TX)
* noted as presenting author
Philip C. Higgins, MSSW, Doctoral candidate, Boston College, Salem, MA

End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care.  None include caregiver perception of patient suffering and prolongation of death. We developed and validated the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a more comprehensive measure of caregiver-perceived quality of EOL care.

Patients and Methods

Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). Caregivers were assessed before and after patient deaths.  CEQUEL’s factor structure was examined; reliability was evaluated using Cronbach’s α, and convergent validity by the strength of associations between CEQUEL scores and key EOL outcomes.


Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The 13-item CEQUEL and its subscales showed moderate to acceptable Cronbach’s α (range: 0.52-0.78). 53% of caregivers reported patients suffering more than expected. Higher CEQUEL scores were positively associated with therapeutic alliance (r=.13; p≤.05) and hospice enrollment (z=-2.09; p≤.05), and negatively associated with bereaved caregiver regret (r=-.36, p≤.001) and trauma symptoms (z=-2.06; p≤.05).


CEQUEL is a brief, valid measure of quality of EOL care from the caregiver’s perspective. It is the first scale to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment.