RATIONALE: Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. OBJECTIVE: To determine patient and family characteristics and chart the documentation of processes of care that are associated with increased family satisfaction with end-of-life decision making for ICU patients. METHODS: We conducted a cohort study of ICUpatients dying in 10 medical centers in the Seattle-Tacoma area. MEASUREMENT: Outcomes from family surveys included summary scores for family satisfaction with decision making and a single-item score that indicated feeling supported during decision making. Predictor variables were obtained from surveys and chart abstraction. MAIN RESULTS: The survey response rate was 41% (442 of 1,074 families responded). Analyses were conducted of 356 families with questionnaire and chart abstraction data. Family satisfaction with decision making was associated with the withdrawal of life support, and chart documentation of physician recommendations to withdraw life support, discussions of patients' wishes, and discussions of families' spiritual needs. Feeling supported during decision making was associated with the withdrawal of life support, spiritual care involvement, and chart documentation of physician recommendations to withdraw life support, expressions of families' wishes to withdraw life support, and discussions of families' spiritual needs. CONCLUSIONS: Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
RCT Entities:
RATIONALE: Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. OBJECTIVE: To determine patient and family characteristics and chart the documentation of processes of care that are associated with increased family satisfaction with end-of-life decision making for ICU patients. METHODS: We conducted a cohort study of ICU patients dying in 10 medical centers in the Seattle-Tacoma area. MEASUREMENT: Outcomes from family surveys included summary scores for family satisfaction with decision making and a single-item score that indicated feeling supported during decision making. Predictor variables were obtained from surveys and chart abstraction. MAIN RESULTS: The survey response rate was 41% (442 of 1,074 families responded). Analyses were conducted of 356 families with questionnaire and chart abstraction data. Family satisfaction with decision making was associated with the withdrawal of life support, and chart documentation of physician recommendations to withdraw life support, discussions of patients' wishes, and discussions of families' spiritual needs. Feeling supported during decision making was associated with the withdrawal of life support, spiritual care involvement, and chart documentation of physician recommendations to withdraw life support, expressions of families' wishes to withdraw life support, and discussions of families' spiritual needs. CONCLUSIONS: Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
Authors: Sally A Norton; Laura A Hogan; Robert G Holloway; Helena Temkin-Greener; Marcia J Buckley; Timothy E Quill Journal: Crit Care Med Date: 2007-06 Impact factor: 7.598
Authors: Daren K Heyland; Graeme M Rocker; Peter M Dodek; Demetrios J Kutsogiannis; Elsie Konopad; Deborah J Cook; Sharon Peters; Joan E Tranmer; Christopher J O'Callaghan Journal: Crit Care Med Date: 2002-07 Impact factor: 7.598
Authors: J Randall Curtis; Paul S Ciechanowski; Lois Downey; Julia Gold; Elizabeth L Nielsen; Sarah E Shannon; Patsy D Treece; Jessica P Young; Ruth A Engelberg Journal: Contemp Clin Trials Date: 2012-07-06 Impact factor: 2.226
Authors: Esther R Smith-Howell; Susan E Hickman; Salimah H Meghani; Susan M Perkins; Susan M Rawl Journal: J Palliat Med Date: 2016-02 Impact factor: 2.947
Authors: Jessica Penn Lendon; Sangeeta C Ahluwalia; Anne M Walling; Karl A Lorenz; Oluwatobi A Oluwatola; Rebecca Anhang Price; Denise Quigley; Joan M Teno Journal: J Pain Symptom Manage Date: 2014-12-24 Impact factor: 3.612
Authors: Erin K Kross; Ruth A Engelberg; Lois Downey; Joseph Cuschieri; Matthew R Hallman; W T Longstreth; David L Tirschwell; J Randall Curtis Journal: Chest Date: 2014-02 Impact factor: 9.410
Authors: Barbara J Daly; Sara L Douglas; Elizabeth O'Toole; Nahida H Gordon; Rana Hejal; Joel Peerless; James Rowbottom; Allan Garland; Craig Lilly; Clareen Wiencek; Ronald Hickman Journal: Chest Date: 2010-06-24 Impact factor: 9.410
Authors: David Y Hwang; Daniel Yagoda; Hilary M Perrey; Tara M Tehan; Mary Guanci; Lillian Ananian; Paul F Currier; J Perren Cobb; Jonathan Rosand Journal: J Neurosci Nurs Date: 2014-04 Impact factor: 1.230
Authors: Eduardo R Nunez; Yael Schenker; Ian D Joel; Charles F Reynolds; Mary Amanda Dew; Robert M Arnold; Amber E Barnato Journal: Crit Care Med Date: 2015-11 Impact factor: 7.598