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Lichtenthal WG, Lief L, Rogers M, Russell D, Viola M, Winoker H, Kakarala S, Traube C, Coats T, Fadalla C, Roberts KE, Pavao M, Osso F, Brewin CR, Pan CX, Maciejewski PK, Berlin D, Pastores S, Halpern N, Vaughan SC, Cox CE, Prigerson HG. EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU. J Pain Symptom Manage 2024; 67:512-524.e2. [PMID: 38479536 PMCID: PMC11110718 DOI: 10.1016/j.jpainsymman.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT Efforts to reduce the psychological distress of surrogate decision-makers of critically ill patients have had limited success, and some have even exacerbated distress. OBJECTIVES The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), an ultra-brief (∼2-hour), 6-module manualized psychological intervention for surrogates. METHODS Surrogates who reported significant anxiety and/or an emotionally close relationship with the patient (n=60) were randomized to receive EMPOWER or enhanced usual care (EUC) at one of three metropolitan hospitals. Participants completed evaluations of EMPOWER's acceptability and measures of psychological distress pre-intervention, immediately post-intervention, and at 1- and 3-month follow-up assessments. RESULTS Delivery of EMPOWER appeared feasible, with 89% of participants completing all 6 modules, and acceptable, with high ratings of satisfaction (mean=4.5/5, SD = .90). Compared to EUC, intent-to-treat analyses showed EMPOWER was superior at reducing peritraumatic distress (Cohen's d = -0.21, small effect) immediately post-intervention and grief intensity (d = -0.70, medium-large effect), posttraumatic stress (d = -0.74, medium-large effect), experiential avoidance (d = -0.46, medium effect), and depression (d = -0.34, small effect) 3 months post-intervention. Surrogate satisfaction with overall critical care (d = 0.27, small effect) was higher among surrogates randomized to EMPOWER. CONCLUSIONS EMPOWER appeared feasible and acceptable, increased surrogates' satisfaction with critical care, and prevented escalation of posttraumatic stress, grief, and depression 3 months later.
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Affiliation(s)
- Wendy G Lichtenthal
- University of Miami Miller School of Medicine (W.G.L.), Miami, Florida, USA; Memorial Sloan Kettering Cancer Center (W.G.L., K.E.R., S.P., N.H.), New York, New York, USA.
| | - Lindsay Lief
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Madeline Rogers
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - David Russell
- Appalachian State University (D.R.), Boone, North Carolina, USA
| | - Martin Viola
- Harvard Medical School (M.V.), Boston, Massachusetts, USA
| | - Hillary Winoker
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Sophia Kakarala
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Chani Traube
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Taylor Coats
- Pacific University (T.C.), Forest Grove, Oregon, USA
| | | | - Kailey E Roberts
- Memorial Sloan Kettering Cancer Center (W.G.L., K.E.R., S.P., N.H.), New York, New York, USA; Yeshiva University (K.E.R.), Bronx, New York, USA
| | - Madison Pavao
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Francesco Osso
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | | | - Cynthia X Pan
- New York-Presbyterian Queens (C.X.P.), Flushing, New York, USA
| | - Paul K Maciejewski
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - David Berlin
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Stephen Pastores
- Memorial Sloan Kettering Cancer Center (W.G.L., K.E.R., S.P., N.H.), New York, New York, USA
| | - Neil Halpern
- Memorial Sloan Kettering Cancer Center (W.G.L., K.E.R., S.P., N.H.), New York, New York, USA
| | - Susan C Vaughan
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
| | - Christopher E Cox
- Duke University School of Medicine (C.E.C.), Durham, North Carolin, USA
| | - Holly G Prigerson
- Weill Cornell Medicine (L.L., M.R., H.W., S.K., C.T., M.P., F.O., P.K.M., D.B., S.C.V., H.G.P.), New York, New York, USA
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Morgenstern LB, Becker CJ, Lank R, Ortiz C, Zhang G, He K, Case E, Zahuranec DB. Long-Term Psychological Distress Among Surrogate Decision Makers for Mexican American and Non-Hispanic White Patients With Severe Stroke. Neurology 2024; 102:e207960. [PMID: 38165320 PMCID: PMC10870740 DOI: 10.1212/wnl.0000000000207960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/06/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES During acute hospitalizations, physicians often focus on the stroke patient and not family who may be traumatized by this sudden change to their loved one. We investigated long-term psychological distress among family surrogate decision makers for Mexican American (MA) and non-Hispanic White (NHW) severe stroke patients. Previous work in other diseases suggested worse psychological outcomes in MA than NHW caregivers. METHODS This was a population-based, prospective cohort study in Nueces County, TX. Stroke patient participants and their surrogate decision makers were enrolled soon after any stroke between April, 2016, and October, 2020, if surrogates had made decisions about life-sustaining treatments. Surrogates completed validated measures of posttraumatic stress, National Stressful Events Survey for Posttraumatic Stress Disorder Short Scale; anxiety, Generalized Anxiety Disorder-7; and depression, Patient Health Questionnaire-8 at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for prespecified patient and surrogate demographic, socioeconomic, and clinical covariates. RESULTS There were 301 family surrogates for 241 severe stroke patients. The mean follow-up was 315 days. High scores on measures of psychological distress ranged between 17% and 28% of surrogates. One or more high levels of the psychological outcomes were found in 17%-43% of surrogates; 2 or more were found in 12%-27%; and all 3 were found in 5%-16% of surrogates. All psychological outcomes were worse among MAs on unadjusted analyses. In fully adjusted models, posttraumatic stress remained worse among MAs (0.36, 95% CI 0.17-0.56); ethnic differences were attenuated and no longer significant in the final model for anxiety (0.59, 95% CI -0.55 to 1.74) and depression (0.97, 95% CI -0.25 to 2.19). The trajectory for depression did differ by ethnicity (interaction p = 0.03), with depression score improving more rapidly over time among NHWs than MAs. Advance care plans did not seem to confound any ethnic differences. DISCUSSION Psychological distress is common among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe stroke.
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Affiliation(s)
- Lewis B Morgenstern
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Christopher J Becker
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Rebecca Lank
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Carmen Ortiz
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Guanghao Zhang
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Kevin He
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Erin Case
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Darin B Zahuranec
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
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Lu SJ, Ku SC, Liu KF, Chien CH. Decision Self-Efficacy and Decisional Conflict on Reintubation among Surrogates of Ventilated Patients Undergoing Planned Extubation. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:235-244. [PMID: 37838098 DOI: 10.1016/j.anr.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
PURPOSE Although the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified. METHODS This study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients' background information was also collected. Univariate and multivariate analyses were performed to model the data. RESULTS The mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates' negative affect on decisional conflict was fully mediated by decision self-efficacy. CONCLUSIONS Surrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.
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Affiliation(s)
- Shu-Ju Lu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuei-Fen Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ching-Hui Chien
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Shen MJ, Prigerson HG, Maciejewski PK. Associations between Latino ethnicity and the use of emotional support and completion of advance directives. Palliat Support Care 2023; 21:385-391. [PMID: 37039467 PMCID: PMC10264148 DOI: 10.1017/s1478951523000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Latino patients have been shown to engage in advance care planning (ACP) at much lower rates than non-Latino White patients. Coping strategies, such as the use of emotional support, may differentially relate to engagement in ACP among Latino and non-Latino patients. The present study sought to examine the moderating effect of ethnicity on the relationship between the use of emotional support as a coping strategy and completion of advance directives. METHODS The present study employed a weighted sample (Nw = 185) of Latino and non-Latino White patient participants in Coping with Cancer III, an National Institutes of Health-sponsored, multisite, longitudinal, observational cohort study of patients with advanced cancer and their informal caregivers and oncology providers designed to evaluate Latino/non-Latino disparities in ACP and end-of-life cancer care. Main and interaction effects of Latino ethnicity and use of emotional support on patient use of advance directives were estimated as odds ratios. RESULTS Use of emotional support was associated with dramatically lower do-not-resuscitate (DNR) order completion to a greater extent among Latino as compared to non-Latino patients (interaction AOR = 0.33, p = 0.005). Interaction effects were not statistically significant for living will or health-care proxy form completion. SIGNIFICANCE OF RESULTS Use of emotional support is associated with lower odds of completing DNRs among Latino than among non-Latino patients. Seeking and/or receiving emotional support may deter Latino patients from completing DNR orders. Research is needed to address both emotional needs and practicalities to ensure high quality end-of-life care among Latino patients with cancer.
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Affiliation(s)
- Megan Johnson Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Paul K Maciejewski
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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McAndrew NS, Erickson J, Hetland B, Guttormson J, Patel J, Wallace L, Visotcky A, Banerjee A, Applebaum AJ. A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation. JOURNAL OF FAMILY NURSING 2023:10748407231166945. [PMID: 37191306 PMCID: PMC10330518 DOI: 10.1177/10748407231166945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA
- Froedtert & the Medical College of Wisconsin, Milwaukee, USA
| | | | - Breanna Hetland
- University of Nebraska Medical Center, Omaha, USA
- Nebraska Medicine, Omaha, USA
| | | | | | | | | | | | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Associations of surrogates' death-preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life. Psychooncology 2022; 31:1502-1509. [PMID: 35793436 DOI: 10.1002/pon.5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Preparing family surrogates for patient death and end-of-life (EOL) decision making may reduce surrogate decisional conflict and regret. Preparedness for patient death involves cognitive and emotional preparedness. We assessed the associations of surrogates' death-preparedness states (that integrate both cognitive and emotional preparedness for patient death) with surrogates' decisional conflict and regret. METHODS Associations of 173 surrogates' death-preparedness states (no, cognitive-only, emotional-only, and sufficient preparedness states) with decisional conflict (measured by the Decision Conflict Scale) and heightened decisional regret (Decision Regret Scale scores >25) were evaluated using hierarchical linear modeling and hierarchical generalized linear modeling, respectively, during a longitudinal observational study at a medical center over cancer patients' last 6 months. RESULTS Surrogates reported high decisional conflict (mean [standard deviation] = 41.48 [6.05]), and 52.7% of assessments exceeded the threshold for heightened decisional regret. Surrogates in the cognitive-only preparedness state reported a significantly higher level of decisional conflict (β = 3.010 [95% CI = 1.124, 4.896]) than those in the sufficient preparedness state. Surrogates in the no (adjusted odds ratio [AOR] [95% CI] = 0.293 [0.113, 0.733]) and emotional-only (AOR [95% CI] = 0.359 [0.149, 0.866]) preparedness states were less likely to suffer heightened decisional regret than those in the sufficient preparedness state. CONCLUSIONS Surrogates' decisional conflict and heightened decisional regret are associated with their death-preparedness states. Improving emotional preparedness for the patient's death among surrogates in the cognitive-only preparedness state and meeting the specific needs of those in the no, emotional-only, and sufficient preparedness states are actionable high-quality EOL-care interventions that may lessen decisional conflict and decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, China
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Takaoka Y, Hamatani Y, Shibata T, Oishi S, Utsunomiya A, Kawai F, Komiyama N, Mizuno A. Quality indicators of palliative care for cardiovascular intensive care. J Intensive Care 2022; 10:15. [PMID: 35287745 PMCID: PMC8922808 DOI: 10.1186/s40560-022-00607-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
Healthcare providers working for cardiovascular intensive care often face challenges and they play an essential role in palliative care and end-of-life care because of the high mortality rates in the cardiac intensive care unit. Unfortunately, there are several barriers to integrating palliative care, cardiovascular care, and intensive care. The main reasons are as follows: cardiovascular disease-specific trajectories differ from cancer, there is uncertainty associated with treatments and diagnoses, aggressive treatments are necessary for symptom relief, and there is ethical dilemma regarding withholding and withdrawal of life-sustaining therapy. Quality indicators that can iterate the minimum requirements of each medical discipline could be used to overcome these barriers and effectively practice palliative care in cardiovascular intensive care. Unfortunately, there are no specific quality indicators for palliative care in cardiovascular intensive care. A few indicators and their domains are useful for understanding current palliative care in cardiovascular intensive care. Among them, several domains, such as symptom palliation, patient- and family-centered decision-making, continuity of care, and support for health care providers that are particularly important in cardiovascular intensive care. Historically, the motivation for using quality indicators is to summarize mechanisms for external accountability and verification, and formative mechanisms for quality improvement. Practically, when using quality indicators, it is necessary to check structural indicators in each healthcare service line, screen palliative care at the first visit, and integrate palliative care teams with other professionals. Finally, we would like to state that quality indicators in cardiovascular intensive care could be useful as an educational tool for practicing palliative care, understanding the minimum requirements, and as a basic structure for future discussions.
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Affiliation(s)
- Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Shogo Oishi
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Akemi Utsunomiya
- Department of Critical Care Nursing, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fujimi Kawai
- St. Luke's International University Library, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan. .,Penn Medicine Nudge Unit, University of Pennsylvania Philadelphia, Philadelphia, PA, USA. .,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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