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- Title
Associations between Family Satisfaction with End-of-Life Care and Chart-Derived, Process-Based Quality Indicators in Intensive Care Units.
- Authors
Chou, Wen-Chi; Huang, Chung-Chi; Hu, Tsung-Hui; Chuang, Li-Pang; Chiang, Ming Chu; Tang, Siew Tzuh
- Abstract
Background/Objective: Evidence linking process-based, high-quality end-of-life (EOL) care indicators to family satisfaction with EOL care in intensive care units (ICUs) remains limited. This study aimed to fill this gap. Design/Setting/Subjects/Measures/Statistical Analysis: For this exploratory, prospective, longitudinal observational study, 278 family members were consecutively recruited from medical ICUs at two medical centers in Taiwan. Family satisfaction with ICU care was surveyed in the first month after patient death using the Family Satisfaction in the ICU questionnaire (FS-ICU). Associations between FS-ICU scores and process-based quality indicators collected over the patient's ICU stay were examined using generalized estimating equations. Results: Documentation of process-based indicators of high-quality EOL care was generally associated with higher scores for both the FS-ICU Care and FS-ICU Decision-Making domains. Higher family satisfaction with ICU care was significantly associated with physician–family prognostic communication (β [95% confidence interval (CI)]: 3.558 [2.963 to 4.154]), a do-not-resuscitate (DNR) order in place at death (23.095 [17.410 to 28.779]), and death without cardiopulmonary resuscitation (CPR) (13.325 [11.685 to 14.965]). Family members' satisfaction with decision making was positively associated with documentation of social worker involvement (4.767 [0.663 to 8.872]), a DNR order issued (10.499 [0.223 to 20.776]), and withdrawal of life-sustaining treatments (LSTs) before death (2.252 [1.834 to 2.670]). Conclusions: EOL care processes are associated with family satisfaction with EOL care in ICUs. Bereaved family members' satisfaction with EOL care in ICUs may be improved by promoting physician–family prognostic communication and psychosocial support, facilitating a DNR order and death without CPR, and withdrawing LSTs for patients dying in ICUs.
- Subjects
TAIWAN; INTENSIVE care units; RESEARCH; CARDIOPULMONARY resuscitation; TERMINAL care; KEY performance indicators (Management); SCIENTIFIC observation; CONFIDENCE intervals; SOCIAL workers; FAMILIES; SATISFACTION; DO-not-resuscitate orders; SURVEYS; DOCUMENTATION; CATASTROPHIC illness; CLINICAL medicine; CRITICAL care medicine; QUESTIONNAIRES; DECISION making; COMMUNICATION; PHYSICIANS; LONGITUDINAL method
- Publication
Journal of Palliative Medicine, 2022, Vol 25, Issue 3, p368
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2021.0304