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Piers RD, Banner-Goodspeed V, Åkerman E, Kieslichova E, Meyfroidt G, Gerritsen RT, Uyttersprot E, Benoit DD. Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses: Differences Between Patients < 75 and ≥ 75 Years of Age? Chest 2023; 164:656-666. [PMID: 37062350 DOI: 10.1016/j.chest.2023.04.018] [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: 12/12/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The benefit of the ICU for older patients is often debated. There is little knowledge on subjective impressions of excessive care in ICU nurses and physicians combined with objective patient data in real-life cases. RESEARCH QUESTION Is there a difference in treatment limitation decisions and 1-year outcomes in patients < 75 and ≥ 75 years of age, with and without concordant perceptions of excessive care by two or more ICU nurses and physicians? STUDY DESIGN AND METHODS This was a reanalysis of the prospective observational DISPROPRICUS study, performed in 56 ICUs. Nurses and physicians completed a daily questionnaire about the appropriateness of care for each of their patients during a 28-day period in 2014. We compared the cumulative incidence of patients with concordant perceptions of excessive care, treatment limitation decisions, and the proportion of patients attaining the combined end point (death, poor quality of life, or not being at home) at 1 year across age groups via Cox regression with propensity score weighting and Fisher exact tests. RESULTS Of 1,641 patients, 405 (25%) were ≥ 75 years of age. The cumulative incidence of concordant perceptions of excessive care was higher in older patients (13.6% vs 8.5%; P < .001). In patients with concordant perceptions of excessive care, we found no difference between age groups in risk of death (1-year mortality, 83% in both groups; P > .99; hazard ratio [HR] after weighting, 1.11; 95% CI, 0.74-1.65), treatment limitation decisions (33% vs 31%; HR after weighting, 1.11; 95% CI, 0.69-2.17), and reaching the combined end point at 1 year (90% vs 93%; P = .546). In patients without concordant perceptions of excessive care, we found a difference in risk of death (1-year mortality, 41% vs 30%; P < .001; HR after weighting, 1.38; 95% CI, 1.11-1.73) and treatment limitation decisions (11% vs 5%; P < .001; HR, 2.11; 95% CI, 1.37-3.27); however, treatment limitation decisions were mostly documented prior to ICU admission. The risk of reaching the combined end point was higher in the older adults (61.6% vs 52.8%; P < .001). INTERPRETATION Although the incidence of perceptions of excessive care is slightly higher in older patients, there is no difference in treatment limitation decisions and 1-year outcomes between older and younger patients once patients are identified by concordant perceptions of excessive care. Additionally, in patients without concordant perceptions, the outcomes are worse in the older adults, pleading against ageism in ICU nurses and physicians.
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Affiliation(s)
- Ruth D Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eva Åkerman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; General Intensive Care Unit, Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Kieslichova
- Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Emma Uyttersprot
- Department of Applied Mathematics and Computer Sciences, Ghent University, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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2
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Ajzenberg H, Dainty KN, O'Connor E. Recommendation-making in the emergency department: A qualitative study of how Canadian emergency physicians guide treatment decisions about resuscitation in critically ill patients. J Am Coll Emerg Physicians Open 2023; 4:e12962. [PMID: 37229184 PMCID: PMC10204169 DOI: 10.1002/emp2.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Study Objective Emergency physicians are frequently responsible for making time-sensitive decisions around the provision of life-sustaining treatment. These decisions can involve goals of care or code status discussion, which will often substantially alter a patient's care pathway. A central part of these conversations that has received relatively little attention are recommendations for care. By proposing a best course of action or treatment via a recommendation, a clinician can ensure that their patients receive care that is concordant with their values. The objective of this study is to explore emergency physicians' attitudes toward recommendations about resuscitation in critically ill patients in the emergency department (ED). Methods We recruited Canadian emergency physicians via multiple recruitment strategies to ensure maximum variation sampling. Semi-structured qualitative interviews were conducted until thematic saturation occurred. Participants were asked about their perspectives and experiences with respect to recommendation-making in critically ill patients and to identify areas for improvement in this process in the ED. We used a qualitative descriptive approach and thematic analysis to identify themes around recommendation-making in the ED for critically ill patients. Results Sixteen emergency physicians agreed to participate. We identified four themes and multiple subthemes. Major themes included identification of the roles and responsibilities of the emergency physician (EP) with respect to making a recommendation, the logistics or process of making a recommendation, barriers to making a recommendation, and how to improve recommendation-making and goals of care conversations in the ED. Conclusion Emergency physicians provided a range of perspectives on the role of recommendation-making in critically ill patients in the ED. Several barriers to the inclusion of a recommendation were identified and many physicians provided ideas on how to improve goals of care conversations, the recommendation-making process, and ensure that critically ill patients receive care that is concordant with their values.
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Affiliation(s)
- Henry Ajzenberg
- Division of Emergency MedicineUniversity of TorontoTorontoOntarioCanada
| | - Katie N. Dainty
- North York General Hospital, Institute of Health Policy Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Erin O'Connor
- Divisions of Emergency Medicine and Palliative MedicineDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
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3
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Ponnapa Reddy MR, Kadam U, Lee JDY, Chua C, Wang W, McPhail T, Lee J, Yarwood N, Majumdar M, Subramaniam A. Family satisfaction with intensive care unit communication during the COVID-19 pandemic: a prospective multicentre Australian study Family Satisfaction - COVID ICU. Intern Med J 2022; 53:481-491. [PMID: 36346289 PMCID: PMC9877714 DOI: 10.1111/imj.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Virtual communication has become common practice during the coronavirus disease 2019 (COVID-19) pandemic because of visitation restrictions. AIMS The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS-ICU) care involving virtual communication strategies during the COVID-19 pandemic period. METHODS In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS-ICU 24-questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS-ICU/dm (satisfaction with information/decision-making) and FS-ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. RESULTS Seventy-three of the 227 patients' NOK who initially agreed completed the FS-ICU questionnaire (response rate 32.2%). The mean FS-ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS-ICU/total scores between survivors (n = 65; 89%) and non-survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS-ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS-ICU/dm. CONCLUSIONS There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.
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Affiliation(s)
- Mallikarjuna Reddy Ponnapa Reddy
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineCalvary Public HospitalBruceAustralian Capital TerritoryAustralia
| | - Umesh Kadam
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia,Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - John Dong Young Lee
- Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Clara Chua
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Wei Wang
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tomecka McPhail
- Department of Social WorkWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Jodie Lee
- Department of Social WorkMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Naomi Yarwood
- Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - Mainak Majumdar
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Ashwin Subramaniam
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Peninsula Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
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4
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Boulton AJ, Jordan H, Adams CE, Polgarova P, Morris AC, Arora N. Intensive care unit visiting and family communication during the COVID-19 pandemic: A UK survey. J Intensive Care Soc 2022; 23:293-296. [PMID: 36033248 PMCID: PMC9403523 DOI: 10.1177/17511437211007779] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Frequent visiting and communication with patients' families are embedded within normal ICU practice, however the COVID-19 pandemic has challenged this, and it is unclear how ICUs are managing. We aimed to investigate how NHS ICUs are approaching family communications and visiting during the COVID-19 pandemic. Methods An electronic snapshot survey was delivered between 16th April and 4th May 2020 and was open to NHS ICUs. Replies from 134 individual ICUs with COVID patients were included. Results All reported that visiting was more restricted than normal with 29 (22%) not allowing any visitors, 71 (53%) allowing visitors at the end of a patient's life (EOL) only, and 30 (22%) allowing visitors for vulnerable patients or EOL. Nearly all (n = 130, 97%) were updating families daily, with most initiating the update (n = 120, 92%). Daily telephone calls were routinely made by the medical (n = 75, 55%) or nursing team (n = 50, 37%). Video calling was used by 63 (47%), and 39 (29%) ICUs had developed a dedicated family communication team. Resuscitation and EOL discussions were most frequently via telephone (n = 129, 96%), with 24 (18%) having used video calling, and 15 (11%) reporting discussions had occurred in person. Clinicians expressed their dissatisfaction with the situation and raised concerns about the detrimental effect on patients, families, and staff. Conclusions COVID-19 has resulted in significant changes across NHS ICUs in how they interact with families. Many units are adapting and moving toward distant and technology-assisted communication. Despite innovative solutions, challenges remain and there may be a role for local and national guidance.
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Affiliation(s)
- Adam J Boulton
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Jordan
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Claire E Adams
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Petra Polgarova
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.,John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Nitin Arora
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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5
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Van Scoy LJ, Scott AM, Green MJ, Witt PD, Wasserman E, Chinchilli VM, Levi BH. Communication Quality Analysis: A user-friendly observational measure of patient-clinician communication. COMMUNICATION METHODS AND MEASURES 2022; 16:215-235. [PMID: 37063460 PMCID: PMC10104441 DOI: 10.1080/19312458.2022.2099819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Communication Quality Analysis (CQA) is a rigorous transcript-based coding method for assessing clinical communication quality. We compared the resource-intensive transcript-based version with a streamlined real-time version of the method with respect to feasibility, validity, reliability, and association with traditional measures of communication quality. Simulated conversations between 108 trainees and 12 standardized patients were assessed by 7 coders using the two versions of CQA (transcript and real-time). Participants also completed two traditional communication quality assessment measures. Real-time CQA was feasible and yielded fair to excellent reliability, with some caveats that can be addressed in future work. CQA ratings were moderately correlated with traditional measures of communication quality, suggesting that CQA captures different aspects of communication quality than do traditional measures. Finally, CQA did not exhibit the ceiling effects observed in the traditional measures of communication quality. We conclude that real-time CQA is a user-friendly method for assessing communication quality that has the potential for broad application in training, research, and intervention contexts and may offer improvements to traditional, self-rated communication measures.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Allison M Scott
- Department of Communication; University of Kentucky, Lexington, USA
| | - Michael J. Green
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
| | - Pamela D. Witt
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Pediatrics Penn State College of Medicine, Hershey, USA
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6
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Robin S, Labarriere C, Sechaud G, Dessertaine G, Bosson JL, Payen JF. Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU: An Assessor-Blinded, Randomized Controlled Trial. Chest 2021; 159:2301-2308. [PMID: 33549600 DOI: 10.1016/j.chest.2021.01.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/15/2020] [Accepted: 01/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Symptoms of posttraumatic stress disorder (PTSD) are common in family members of patients who have died in the ICU. RESEARCH QUESTION Could a pamphlet describing the role of relatives in the end-of-life decision decrease their risk of developing PTSD-related symptoms? STUDY DESIGN AND METHODS In this assessor-blinded, randomized controlled trial, 90 relatives of adult patients for whom an end-of-life decision was anticipated were enrolled. Relatives were randomly assigned to receive oral information as well as an information pamphlet explaining that the end-of-life decision is made by physicians (Group 1; n = 45) or oral information alone (Group 2; n = 45). PTSD-related symptoms were blindly assessed at 90 days following the patient's death by using the Impact of Event Scale (scores range from 0 [indicating no symptoms] to 75 [indicating severe symptoms]). Anxiety and depression symptoms were assessed by using the Hospital Anxiety and Depression Scale score (range, 0-21 [higher scores indicate worse symptoms]). RESULTS On day 90, the number of relatives with PTSD-related symptoms was significantly lower in Group 1 than in Group 2: 18 of 45 vs 33 of 45 (P = .001). The risk ratio of having PTSD-related symptoms in Group 2 compared with Group 1 was 1.8 (95% CI, 1.2-2.7). The mean Impact of Event Scale and Hospital Anxiety and Depression Scale scores were significantly reduced in Group 1 compared with Group 2: 28 ± 10 vs 38 ± 14 (P < .001) and 13 ± 5 vs 17 ± 8 (P = .023), respectively. INTERPRETATION An information pamphlet describing the relatives' role during end-of-life decisions significantly reduced their risk of developing PTSD-related symptoms. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02329418; URL: www.clinicaltrials.gov).
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Affiliation(s)
- Sylvaine Robin
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Cyrielle Labarriere
- Department of Anesthesia and Critical Care, Annecy Genevois Hospital, Annecy, France
| | - Guillaume Sechaud
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Geraldine Dessertaine
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Luc Bosson
- Department of Public Health, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Francois Payen
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
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Beneria A, Castell-Panisello E, Sorribes-Puertas M, Forner-Puntonet M, Serrat L, García-González S, Garriga M, Simon C, Raya C, Montes MJ, Rios G, Bosch R, Citoler B, Closa H, Corrales M, Daigre C, Delgado M, Dip ME, Estelrich N, Jacas C, Lara B, Lugo-Marin J, Nieto-Fernández Z, Regales C, Ibáñez P, Blanco E, Ramos-Quiroga JA. End of Life Intervention Program During COVID-19 in Vall d'Hebron University Hospital. Front Psychiatry 2021; 12:608973. [PMID: 34040548 PMCID: PMC8143029 DOI: 10.3389/fpsyt.2021.608973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/06/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: The coronavirus disease 19 (COVID-19) and its consequences have placed our societies and healthcare systems under pressure. Also, a major impact on the individual and societal experience of death, dying, and bereavement has been observed. Factors such as social distancing, unexpected death or not being able to say goodbye, which might predict Prolonged Grief Disorder (PGD), are taking place. Moreover, hospitals have become a habitual place for End of Life (EOL) situations but not in the usual conditions because, for example, mitigation measures prevent families from being together with hospitalized relatives. Therefore, we implemented an EOL program with a multidisciplinary team involving health social workers (HSW) and clinical psychologists (CP) in coordination with the medical teams and nursing staff. Objectives: We aim to describe an EOL intervention program implemented during COVID-19 in the Vall d'Hebron University Hospital (HUVH). We present its structure, circuit, and functions. Descriptive analyses of the sample and the interventions that required psychological and social attention are reported. Material and methods: The total sample consists of 359 relatives of 219 EOL patients. Inclusion criteria were families cared for during the COVID-19 pandemic with family patients admitted to the HUVH in an EOL situation regardless of whether or not the patient was diagnosed with COVID-19. Results: Our program is based on family EOL care perceptions and the COVID-19 context features that hinder EOL situations. The program attended 219 families, of which 55.3% were COVID-19 patients and 44.7% had other pathologies. The EOL intervention program was activated in most of the EOL situations, specifically, in 85% of cases, and 78% of relatives were able to come and say goodbye to their loved ones. An emotional impact on the EOL team was reported. It is necessary to dignify the EOL situation in the COVID-19 pandemic, and appropriate psychosocial attention is needed to try to minimize future complications in grief processes and mitigate PGD.
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Affiliation(s)
- Anna Beneria
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Eudald Castell-Panisello
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Sorribes-Puertas
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mireia Forner-Puntonet
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Serrat
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara García-González
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Garriga
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carmen Simon
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Consuelo Raya
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria José Montes
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giuliana Rios
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Bosch
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Bárbara Citoler
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Helena Closa
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Corrales
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Constanza Daigre
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Mercedes Delgado
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Emilia Dip
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Neus Estelrich
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carlos Jacas
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Benjamin Lara
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Lugo-Marin
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Zaira Nieto-Fernández
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Christina Regales
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pol Ibáñez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Eunice Blanco
- Department of Social Work, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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8
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Laryionava K, Hauke D, Heußner P, Hiddemann W, Winkler EC. "Often Relatives are the Key […]" -Family Involvement in Treatment Decision Making in Patients with Advanced Cancer Near the End of Life. Oncologist 2020; 26:e831-e837. [PMID: 33037846 PMCID: PMC8100569 DOI: 10.1002/onco.13557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Family communication has been increasingly recognized as an important factor in decision making near the end of life. However, the role of the family in decision making is less studied in oncology settings, where most patients are conscious and able to communicate almost until dying. The aim of this study was to explore oncologists’ and nurses’ perceptions of family involvement in decision making about forgoing cancer‐specific treatment in patients with advanced cancer. Materials and Methods Qualitative semistructured interviews with 22 oncologists and 7 oncology nurses were analyzed according to the grounded theory approach. The results were discussed against the background of the clinical and ethical debate on family role near the end of life. Results We could identify two approaches shared by both oncologists and nurses toward family involvement. These approaches could be partly explained by different perception and definition of the concept of patients' autonomy: (a) a patient‐focused approach in which a patient's independence in decision making was the highest priority for oncologists and (b) a mediator approach with a family focus in which oncologists and nurses assigned an active role to patients' family in decision making and strived for building consensus and resolving conflicts. Conclusion The main challenge was to involve family, increasing their positive influences on the patient and avoiding a negative one. Thereby, the task of both oncologists and oncology nurses is to support a patient's family in understanding of a patient's incurable condition and to identify a patient's preference for therapy. Implications for Practice This study focused on oncologists’ and oncology nurses’ perceptions of family involvement in decision making about treatment limitation in patients with advanced cancer who are able to communicate in a hospital setting. Oncologists and oncology nurses should be aware of both positive aspects and challenges of family involvement. Positive aspects are patients’ emotional support and support in understanding and managing the information regarding treatment decisions. Challenges are diverging family preferences with regard to treatment goals that might become a barrier to advanced care planning, a possible increased psychological burden for the family. Especially challenging is involving the family of a young patient because increased attention, more time investment, and detailed discussions are needed. The role of family communication is recognized as an important factor in decision making for cancer patients near the end of life. This article discusses the value and role of family in end‐of‐life discussions and the challenges encountered by oncologist and oncology nurses when involving family in decision making.
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Affiliation(s)
- Katsiaryna Laryionava
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg (Saale), Germany
| | - Daniela Hauke
- Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich, Germany
| | - Pia Heußner
- Oncological Center Oberland, Hospital Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich, Germany
| | - Eva C Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Kamran R, Dal Cin A. Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology. BMC Palliat Care 2020; 19:151. [PMID: 33023545 PMCID: PMC7542118 DOI: 10.1186/s12904-020-00659-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Eliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care. METHODS Design-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature. RESULTS Issues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this. CONCLUSIONS Our "Mission Statement" mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, MDCL 3114, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Arianna Dal Cin
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada
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10
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Selman LE, Chao D, Sowden R, Marshall S, Chamberlain C, Koffman J. Bereavement Support on the Frontline of COVID-19: Recommendations for Hospital Clinicians. J Pain Symptom Manage 2020; 60:e81-e86. [PMID: 32376262 PMCID: PMC7196538 DOI: 10.1016/j.jpainsymman.2020.04.024] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
Deaths due to COVID-19 are associated with risk factors which can lead to prolonged grief disorder, post-traumatic stress, and other poor bereavement outcomes among relatives, as well as moral injury and distress in frontline staff. Here we review relevant research evidence and provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. For relatives, bereavement risk factors include dying in an intensive care unit, severe breathlessness, patient isolation or restricted access, significant patient and family emotional distress, and disruption to relatives' social support networks. Recommendations include advance care planning; proactive, sensitive, and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; providing excellent symptom management and emotional and spiritual support; and providing and/or sign-posting to bereavement services. To mitigate effects of this emotionally challenging work on staff, we recommend an organizational and systemic approach which includes access to informal and professional support.
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Affiliation(s)
- Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Davina Chao
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryann Sowden
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steve Marshall
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Palliative Care Service, London, UK
| | - Charlotte Chamberlain
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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11
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Lazea D, Varelmann DJ. Speaking for the Dying: Life-and-Death Decisions in Intensive Care. Anesth Analg 2020. [DOI: 10.1213/ane.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Kawashima T, Tanaka M, Kawakami A, Muranaka S. Nurses' contribution to end-of-life family conferences in critical care: A Delphi study. Nurs Crit Care 2020; 25:305-312. [PMID: 32383497 DOI: 10.1111/nicc.12512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/20/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family conferences (FCs) in the intensive care unit play an important role in reducing the psychological burden of patients' families at the end of life. However, no studies have clarified the specific roles and contributions of nurses related to FCs for terminally ill patients in critical care and their families. AIMS AND OBJECTIVES To clarify nurses' contribution to FCs for terminally ill patients in critical care and their families and examine the priority of each item. DESIGN A modified Delphi method was used. METHODS This study consisted of two phases. In phase 1, an initial list was developed based on a literature review, individual interviews, and a focus group interview. Phase 2 involved two rounds of the Delphi survey. Practitioners (N = 55) from hospitals across Japan were recruited to the Expert Panel for phase 2. They were asked to rate each nurse's contribution in terms of its importance using a 9-point Likert scale (1 being "not important at all" to 9 being "very important"). Fifty participants responded to round 1 of the survey, and 46 participants completed round 2. If at least 80% of the panellists chose an importance level of 7 or higher, the item was considered "important". RESULTS The 65 items of the potential list were classified into three domains: preparation (16 items), discussion and facilitating meaning during a FC (32 items), and follow up after a FC (17 items). The expert panel determined that, of 65 items, 49 items on the proposed list of nurses' contribution were considered important. CONCLUSIONS This study clarified nurses' contribution to FCs, with consensus on their importance by expert nurses. RELEVANCE TO CLINICAL PRACTICE This study could be useful for improving and ensuring the quality of nurses' contribution to FCs and promoting collaboration between nurses and other medical professionals.
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Affiliation(s)
- Tetsuharu Kawashima
- Department of Critical and Invasive-Palliative Care Nursing, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Aki Kawakami
- Department of Critical and Invasive-Palliative Care Nursing, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Saori Muranaka
- Department of Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, Japan
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Hirshberg EL, Butler J, Francis M, Davis FA, Lee D, Tavake-Pasi F, Napia E, Villalta J, Mukundente V, Coulter H, Stark L, Beesley SJ, Orme JF, Brown SM, Hopkins RO. Persistence of patient and family experiences of critical illness. BMJ Open 2020; 10:e035213. [PMID: 32265244 PMCID: PMC7245383 DOI: 10.1136/bmjopen-2019-035213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate: (1) patient and family experiences with healthcare and the intensive care unit (ICU); (2) experiences during their critical illness; (3) communication and decision making during critical illness; (4) feelings about the ICU experience; (5) impact of the critical illness on their lives; and (6) concerns about their future after the ICU. DESIGN Four semistructured focus group interviews with former ICU patients and family members. SETTINGS Multicultural community group and local hospitals containing medical/surgical ICUs. PARTICIPANTS Patients and family who experienced a critical illness within the previous 10 years. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four separate focus groups each lasting a maximum of 150 min and consisting of a total of 21 participants were held. Focus groups were conducted using a semistructured script including six topics relating to the experience of critical illness that facilitated deduction and the sorting of data by thematic analysis into five predominant themes. The five main themes that emerged from the data were: (1) personalised stories of the critical illness; (2) communication and shared decision making, (3) adjustment to life after critical illness, (4) trust towards clinical team and relevance of cultural beliefs and (5) end-of-life decision making. Across themes, we observed a misalignment between the medical system and patient and family values and priorities. CONCLUSIONS The experience of critical illness of a diverse group of patients and families can remain vivid for years after ICU discharge. The identified themes reflect the strength of memory of such pivotal experiences and the importance of a narrative around those experiences. Clinicians need to be aware of the lasting effects of critical illness has on patients and families.
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Affiliation(s)
- Eliotte L Hirshberg
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Pediatrics, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - Jorie Butler
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Geriatrics, Univeristy of Utah, Salt Lake City, Utah, USA
- Geriatrics Research Education and Clinical Center, Veterans Affairs Medical Center (VAMC, Salt Lake City, Utah, USA
| | - Morgan Francis
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
| | | | - Doriena Lee
- Community Faces of Utah, Salt Lake City, Utah, USA
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Edwin Napia
- Community Faces of Utah, Salt Lake City, Utah, USA
| | | | | | - Heather Coulter
- Community Faces of Utah, Salt Lake City, Utah, USA
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Louisa Stark
- Community Faces of Utah, Salt Lake City, Utah, USA
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
| | - James F Orme
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Internountain Medical Center, Murray, Utah, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Healthcare, Murray, Utah, USA
- Department of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
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Fuller S. Prolonging life for family: whose suffering is more important? Br J Hosp Med (Lond) 2020; 80:486. [PMID: 31437053 DOI: 10.12968/hmed.2019.80.8.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Silas Fuller
- Junior Clinical Fellow in Critical Care, Department of Critical Care, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH
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15
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Amass TH, Villa G, OMahony S, Badger JM, McFadden R, Walsh T, Caine T, McGuirl D, Palmisciano A, Yeow ME, De Gaudio R, Curtis JR, Levy MM. Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members-A Multicenter, Multinational, Before-and-After Intervention Trial. Crit Care Med 2020; 48:176-184. [PMID: 31939785 PMCID: PMC7147959 DOI: 10.1097/ccm.0000000000004113] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members. DESIGN Prospective, before-and-after intervention evaluation. SETTING Two U.S. academic medical ICU's, and one Italian academic medical/surgical ICU. SUBJECTS Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission. INTERVENTIONS A novel intervention titled "Family Care Rituals" during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay. MEASUREMENTS AND MAIN RESULTS Primary outcome was symptoms of post-traumatic stress disorder in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90-day follow-up, 131 of 226 family members (58.0%) responded preintervention and 129 of 226 family members (57.1%) responded postintervention. Symptoms of post-traumatic stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p = 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p = 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p = 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p = 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge. CONCLUSIONS Offering opportunities such as family care rituals for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of post-traumatic stress disorder. This intervention may lessen the burden of stress-related symptoms in family members of ICU patients.
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Affiliation(s)
- Timothy H Amass
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Brown University, Providence RI, USA
| | - Gianluca Villa
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sean OMahony
- Department of Internal Medicine, Palliative Medicine Section, Rush University Medical Center, Chicago, IL, USA
| | - James M. Badger
- Department of Psychiatry, Brown University, Providence RI, USA
| | - Rory McFadden
- Department of Internal Medicine, Palliative Medicine Section, Rush University Medical Center, Chicago, IL, USA
| | - Thomas Walsh
- Rhode Island Hospital, Research Division of Pulmonary, Critical Care & Sleep, Providence RI, USA
| | - Tanis Caine
- Rhode Island Hospital, Research Division of Pulmonary, Critical Care & Sleep, Providence RI, USA
| | - Don McGuirl
- Rhode Island Hospital, Research Division of Pulmonary, Critical Care & Sleep, Providence RI, USA
| | - Amy Palmisciano
- Rhode Island Hospital, Research Division of Pulmonary, Critical Care & Sleep, Providence RI, USA
| | - Mei-Ean Yeow
- Center for Palliative Care, Mayo Clinic, Rochester, NY, USA
| | - Raffaele De Gaudio
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Mitchell M. Levy
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Brown University, Providence RI, USA
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Allain MC, Besson JM, Blanchard PY, Roge L, Flechel A, Djibre M, Fartoukh M, Labbe V. Évaluation anonyme et continue de la satisfaction des familles des patients hospitalisés en réanimation par l’outil Opinion Family. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
En faisant partie intégrante du processus de soins, les familles des patients hospitalisés en réanimation sont exposées à des agressions à l’origine de troubles psychologiques. Ces situations de fragilité peuvent être, au moins en partie, prévenues par une prise en charge des familles de qualité. Au même titre que la démarche qualité implique l’évaluation de la satisfaction des patients, il paraît donc indispensable de recueillir celle des familles. L’outil OpinionFamily® (OF) a été conçu en partenariat avec une société experte afin de recueillir de façon anonyme, ergonomique, objective et continue la satisfaction des familles concernant leur perception de la qualité de leur prise en charge et de celle de leur proche sur une borne tactile sécurisée disposée dans la salle d’attente. L’analyse en temps réel des réponses permet l’évaluation des pratiques et la mise en place d’actions d’amélioration. Une étude de faisabilité au sein de la réanimation médicochirurgicale de l’hôpital Tenon de mars 2017 à août 2017 a permis le recueil de la satisfaction de 146 proches, essentiellement les référents des patients. L’identification et la disponibilité des soignants, le temps d’attente avant les visites, le confort de la salle d’attente ainsi que l’information relative à l’évolution de l’état de santé des patients demeurent les principaux items nécessitant la mise en oeuvre d’actions d’amélioration. L’implémentation systématique de l’outil OF dans les salles d’attente de réanimation offrirait aux soignants la possibilité de mieux connaître les besoins des familles en fonction de l’organisation mise en place, ainsi que d’évaluer régulièrement les améliorations effectuées.
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Affiliation(s)
- David Kuhl
- Centre for Practitioner Renewal, Providence Health Care/University of British Columbia, Vancouver, British Columbia. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia; and Hornby Site, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6
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18
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Stajduhar KI, Funk L, Cohen SR, Williams A, Bidgood D, Allan D, Norgrove L, Heyland D. Bereaved Family Members’ assessments of the quality of End-Of-Life Care: What is Important? J Palliat Care 2018. [DOI: 10.1177/082585971102700402] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of patients are well poised to comment on the end-of-life (EOL) care received by those patients and can provide feedback to care providers and decision makers. To better understand family-member evaluations of the quality of in-patient EOL care, this study draws on qualitative interview data (n=24) to identify core aspects of EOL care that are important for family members. Based on this analysis, a conceptual framework of family members’ assessments of their experiences with EOL health care services is developed. Findings suggest the need to distinguish between perceived substantive or tangible features of received care, interpretations of the causes and symbolic meanings of that care, and personal and affective outcomes. Practitioners are encouraged to reflect on how behaviours and communications may be interpreted by families. Attention also needs to be given to the changes in practice and organizational decision making that can facilitate more positive experiences for families and patients.
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Affiliation(s)
- Kelli I. Stajduhar
- KI Stajduhar (corresponding author) School of Nursing and Centre on Aging, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia, Canada V8W 2Y2
| | - Laura Funk
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
| | - S. Robin Cohen
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Allison Williams
- Jewish General Hospital, Montreal, Quebec, Canada; A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Darcee Bidgood
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Diane Allan
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Leah Norgrove
- Department of Community Health and Epidemiology, Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Daren Heyland
- Saanich Peninsula Hospital, Vancouver Island Health Authority, Victoria, British Columbia, Canada
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19
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Peck V, Valiani S, Tanuseputro P, Mulpuru S, Kyeremanteng K, Fitzgibbon E, Forster A, Kobewka D. Advance care planning after hospital discharge: qualitative analysis of facilitators and barriers from patient interviews. BMC Palliat Care 2018; 17:127. [PMID: 30518345 PMCID: PMC6282276 DOI: 10.1186/s12904-018-0379-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Patients who engage in Advance Care Planning (ACP) are more likely to get care consistent with their values. We sought to determine the barriers and facilitators to ACP engagement after discharge from hospital. Methods Prior to discharge from hospital eligible patients received a standardized conversation about prognosis and ACP. Each patient was given an ACP workbook and asked to complete it over the following four weeks. We included frail elderly patients with a high risk of death admitted to general internal medicine wards at a tertiary care academic teaching hospital. Four weeks after discharge we conducted semi-structured interviews with patients. Interviews were transcribed, coded and analysed with thematic analysis. Themes were categorized according to the theoretical domains framework. Results We performed 17 interviews. All Theoretical Domain Framework components except for Social/Professional Identity and Behavioral Regulation were identified in our data. Poor knowledge about ACP and physician communication skills were barriers partially addressed by our intervention. Some patients found it difficult to discuss ACP during an acute illness. For others acute illness made ACP discussions more relevant. Uncertainty about future health motivated some participants to engage in ACP while others found that ACP discussions prevented them from living in the moment and stripped them of hope that better days were ahead. Conclusions For some patients acute illness resulting in admission to hospital can be an opportunity to engage in ACP conversations but for others ACP discussions are antithetical to the goals of hospital care. Electronic supplementary material The online version of this article (10.1186/s12904-018-0379-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vanessa Peck
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward Fitzgibbon
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alan Forster
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Kobewka
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Long AC, Kross EK, Curtis JR. Family-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation. Curr Opin Crit Care 2018; 22:613-620. [PMID: 27685849 DOI: 10.1097/mcc.0000000000000360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. RECENT FINDINGS Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life. Novel measures include assessments of decisional conflict, decision regret, therapeutic alliance, and caregiver burden, as well as positive adaptations and resilience. SUMMARY Critical illness places a significant burden on family members. A wide variety of family-centered outcomes are available to guide improvements in care and communication. Future research should focus on developing sensitive and responsive measures that capture key elements of the family member experience during and after critical illness.
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Affiliation(s)
- Ann C Long
- aDivision of Pulmonary and Critical Care Medicine, Harborview Medical Center bCambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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21
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Kynoch K, Cabilan CJ, McArdle A. Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2018; 14:83-90. [PMID: 27941513 DOI: 10.11124/jbisrir-2016-003193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.
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Affiliation(s)
- Kate Kynoch
- Nursing Research Centre and the Queensland Centre for Evidence-Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence, Mater Misericordiae Limited, Brisbane, Australia
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Family Satisfaction in Critical Care Units: Does an Open Visiting Hours Policy Have an Impact? J Patient Saf 2018; 13:169-174. [PMID: 25136852 DOI: 10.1097/pts.0000000000000140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For critically ill patients, the interaction between health care providers and family members is essential in daily decision making. Improving this relationship has a positive impact on satisfaction with the overall care provided to patients and reduces family member symptoms of depression, anxiety, and posttraumatic stress disorder. In this study, we analyzed the impact of visitation policy (open versus restricted) on family satisfaction using the previously well-validated Critical Care Family Satisfaction Survey (CCFSS) questionnaire. METHODS This is a cross-sectional prospective observational study conducted between November 1, 2009, and January 31, 2010, in 2 critical care units with 2 different visiting policy systems, unit A (open visiting hours) and B (restricted visiting hours), comparing family satisfaction in both units using the CCFSS questionnaire. Responses were grouped in 5 satisfaction constructs, namely, the support construct, which assesses the degree of satisfaction with the support of the intensive care staff as perceived by relatives; the assurance construct, which assesses the degree of satisfaction regarding honest answers being given and the responder's confidence that the patient is receiving the best care possible; the proximity construct, which assesses the degree of satisfaction with the physical and emotional access to the patient; the information construct, which assesses the degree of satisfaction with the adequacy of information given to relatives; and the comfort construct, which assesses satisfaction with physical comfort and amenities. RESULTS During the study period, 115 questionnaires were distributed in each of the 2 sites. The response rates in units A and B were 92% (106) and 100% (115), respectively. The mean stay time in the intensive care unit was 3.7 days. There were more trauma cases in unit A and more cardiac patients in unit B. There was no significant difference between the 2 units in any of the 5 satisfaction constructs, the support, assurance, proximity, information, and comfort constructs, although there was a nonsignificant trend favoring the unit with the more liberal visit policy regarding amenities (unit A). CONCLUSIONS We concluded that family satisfaction to care provided in intensive care as measured by the CCFSS questionnaire was not influenced by frequency of visitation among Saudi families. Factors other than open visiting hours may be important to evaluate.
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Stajduhar K, Sawatzky R, Robin Cohen S, Heyland DK, Allan D, Bidgood D, Norgrove L, Gadermann AM. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. BMC Palliat Care 2017; 16:59. [PMID: 29178901 PMCID: PMC5702136 DOI: 10.1186/s12904-017-0237-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. METHODS A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test - Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. RESULTS Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of "doctor and nurse care", "illness management", "health services" and "communication". The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. CONCLUSION Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.
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Affiliation(s)
- Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - S. Robin Cohen
- Oncology and Medicine, McGill University, Lady Davis Research Institute, Jewish General Hospital, 845 Sherbrooke Street West, Montreal, QC H3A 0G4 Canada
| | - Daren K. Heyland
- Critical Care Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Diane Allan
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SASK S7N 2Z4 Canada
| | - Darcee Bidgood
- Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Leah Norgrove
- Palliative Care, Saanich Peninsula Hospital, Island Health, 2166 Mt. Newton X Road, Saanichton, BC V8M 2B2 Canada
| | - Anne M. Gadermann
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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Hunt KJ, Richardson A, Darlington ASE, Addington-Hall JM. Developing the methods and questionnaire (VOICES-SF) for a national retrospective mortality follow-back survey of palliative and end-of-life care in England. BMJ Support Palliat Care 2017; 9:e5. [PMID: 29101120 DOI: 10.1136/bmjspcare-2016-001288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/31/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
The National Survey of Bereaved People was conducted by the Office for National Statistics on behalf of NHS England for the first time in 2011, and repeated annually thereafter. It is thought to be the first time that nationally representative data have been collected annually on the experiences of all people who have died, regardless of cause and setting, and made publicly available informing palliative and end-of-life policy, service provision and development, and practice. This paper describes the development of the questionnaire used in the survey, VOICES-SF, a short-form of the VOICES (Views Of Informal Carers-Evaluation of Services) questionnaire, adapted specifically to address the aims of the national survey. The pilot study to refine methods for the national survey is also described. The paper also reports on the development of the retrospective, after-death or mortality follow-back method in palliative and end-of-life care, and reviews its strengths and weaknesses.
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Affiliation(s)
- Katherine J Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Frivold G, Slettebø Å, Heyland DK, Dale B. Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study. Nurs Open 2017; 5:6-14. [PMID: 29344389 PMCID: PMC5762765 DOI: 10.1002/nop2.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death. Design A cross‐sectional survey study was conducted. Methods Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis. Results A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.
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Affiliation(s)
- Gro Frivold
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Åshild Slettebø
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Daren K Heyland
- Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada.,The Canadian Researchers at the End of Life Network Kingston ON Canada.,Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
| | - Bjørg Dale
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway.,Centre for Caring Research Southern Norway Grimstad Norway
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Van Scoy LJ, Watson-Martin E, Bohr TA, Levi BH, Green MJ. End-of-Life Conversation Game Increases Confidence for Having End-of-Life Conversations for Chaplains-in-Training. Am J Hosp Palliat Care 2017; 35:592-600. [DOI: 10.1177/1049909117723619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Tiffany A. Bohr
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Benjamin H. Levi
- Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J. Green
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Mahrous MS. Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals. Rev Bras Ter Intensiva 2017; 29:188-194. [PMID: 28591370 PMCID: PMC5496753 DOI: 10.5935/0103-507x.20170018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/14/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives This study aims to identify the satisfaction levels of the family members of
patients in intensive care units. Methods This is a cross-sectional analytical study. General intensive care units
offer a variety of services to clinical and surgical patients. For the
purpose of this study, a trained interviewer communicated with the families
of patients, either before or after visiting hours. Results The study included 208 participants: 119 (57.2%) males and 89 (42.8%)
females. Seventy-three (35.1%) of the patients attended a private hospital,
and 135 (64.9%) attended a public hospital in the city of Al Madinah Al-
Munawarah. All of the participants were either family members or friends of
patients admitted to the intensive care units at the hospitals. The
responses of both groups yielded low scores on the satisfaction index.
However, a relatively high score was noted in response to questions 2, 6,
and 10, which concerned the care that was extended by the hospital staff to
their patients, the courteous attitude of intensive care unit staff members
towards patients, and patients' satisfaction with the medical care provided,
respectively. A very low score was obtained for item 11, which was related
to the possibility for improvements to the medical care that the patients
received. Overall, greater satisfaction with the services offered by the
public intensive care units was reported compared to the satisfaction with
the services offered by the private intensive care units. Conclusion An overall low score on the satisfaction index was obtained, and further
studies are recommended to assess the current situation and improve the
satisfaction and quality of care provided by intensive care units.
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28
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Gerritsen RT, Koopmans M, Hofhuis JG, Curtis JR, Jensen HI, Zijlstra JG, Engelberg RA, Spronk PE. Comparing Quality of Dying and Death Perceived by Family Members and Nurses for Patients Dying in US and Dutch ICUs. Chest 2017; 151:298-307. [DOI: 10.1016/j.chest.2016.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/05/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
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Arutyunyan T, Odetola F, Swieringa R, Niedner M. Religion and Spiritual Care in Pediatric Intensive Care Unit: Parental Attitudes Regarding Physician Spiritual and Religious Inquiry. Am J Hosp Palliat Care 2016; 35:28-33. [PMID: 27940902 DOI: 10.1177/1049909116682016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Parents of seriously ill children require attention to their spiritual needs, especially during end-of-life care. The objective of this study was to characterize parental attitudes regarding physician inquiry into their belief system. Materials and Main Results: A total of 162 surveys from parents of children hospitalized for >48 hours in pediatric intensive care unit in a tertiary academic medical center were analyzed. Forty-nine percent of all respondents and 62% of those who identified themselves as moderate to very spiritual or religious stated that their beliefs influenced the decisions they made about their child's medical care. Although 34% of all respondents would like their physician to ask about their spiritual or religious beliefs, 48% would desire such enquiry if their child was seriously ill. Those who identified themselves as moderate to very spiritual or religious were most likely to welcome the discussion ( P < .001). Two-thirds of the respondents would feel comforted to know that their child's physician prayed for their child. One-third of all respondents would feel very comfortable discussing their beliefs with a physician, whereas 62% would feel very comfortable having such discussions with a chaplain. CONCLUSION The study findings suggest parental ambivalence when it comes to discussing their spiritual or religious beliefs with their child's physicians. Given that improved understanding of parental spiritual and religious beliefs may be important in the decision-making process, incorporation of the expertise of professional spiritual care providers may provide the optimal context for enhanced parent-physician collaboration in the care of the critically ill child.
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Affiliation(s)
- Tsovinar Arutyunyan
- 1 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA
| | - Folafoluwa Odetola
- 1 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ryan Swieringa
- 2 Spiritual Care Department, University of Michigan Health System, Ann Arbor, MI, USA
| | - Matthew Niedner
- 1 Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA
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Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9025643. [PMID: 28044138 PMCID: PMC5156795 DOI: 10.1155/2016/9025643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022]
Abstract
Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.
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Vincent JL, Berré J, Creteur J. Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective. Chron Respir Dis 2016; 1:115-20. [PMID: 16279270 DOI: 10.1191/1479972304cd021rs] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:Many deaths are now preceded by an end of life decision, particularly in the intensive care unit (ICU), but such practices vary considerably between countries, ICUs and individuals, depending on many factors including cultural and religious background, family and peer pressure and local practice. Aims:In this review, we will discuss the application of the four key ethical principles-beneficence, nonmaleficence, autonomy and distributive justice - to withdrawing/withholding decisions. Methods: Drawing data from several national and international studies, we then summarize the current situation across Europe regarding such practices before making some suggestions as to how we could facilitate the often difficult decision making process by improved communication between staff, patient and relatives.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
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32
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Akroute AR, Bondas T. Critical care nurses and relatives of elderly patients in intensive care unit–Ambivalent interaction. Intensive Crit Care Nurs 2016; 34:59-72. [DOI: 10.1016/j.iccn.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/19/2015] [Accepted: 08/07/2015] [Indexed: 12/31/2022]
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Family Experiences During the Dying Process After Withdrawal of Life-Sustaining Therapy. Dimens Crit Care Nurs 2016; 35:160-6. [DOI: 10.1097/dcc.0000000000000174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND Intensive care units (ICUs) exist to support patients through acute illness that threatens their life. Although ICUs aim to save life, they are also a place where a significant proportion of patients die with international mortality rates ranging from 15% to 24%. AIM To explore the experience of relatives and staff of patients dying in ICU using qualitative approach. DESIGN Consecutive patients were identified who were dying in the ICU. The researcher met the families prior to the patient's death. The ICU nurse and doctor most involved were interviewed within 48 h of the death. The families were interviewed 2 weeks later. Interviewees described their experience of the patient's dying and death. Recruitment until data saturation and thematic analysis occurred concurrently. RESULTS Ten families, nurses and doctors were interviewed in relation to 10 patients. In caring for the patients who are dying in the ICU and their families, nurses practice to their satisfaction with creativity and autonomy, although concerned about continuity of care at handover. Families appreciate kindness and regular sensitive communication. Families would like more contact with the ICU doctors. Limiting access to the patient according to ICU protocol is distressing for relatives. Doctors struggle with decision making, determining prognosis and witnessing the grief of relatives. Some doctors wish to have a greater part in care of the dying patient. CONCLUSION Distress among nurses reported in the ICU literature and attributed to disenfranchisement by doctors was not evident. In contrast, some doctors struggle to practice what they value. Adherence to ICU protocols needs flexibility when a patient is dying.
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Affiliation(s)
| | - A Psirides
- Intensive Care Department, Wellington Regional Hospital, Aotearoa, New Zealand
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Prochaska MT, Sulmasy DP. Recommendations to Surrogates at the End of Life: A Critical Narrative Review of the Empirical Literature and a Normative Analysis. J Pain Symptom Manage 2015; 50:693-700. [PMID: 26025276 DOI: 10.1016/j.jpainsymman.2015.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
Physician recommendations have historically been a part of shared decision making. Recent literature has challenged the idea that physician recommendations should be part of shared decision making at the end of life, particularly the making of recommendations to surrogates of incapacitated patients. Close examination of the studies and the available data on surrogate preferences for decisional authority at the end of life, however, provide an empirical foundation for a style of shared decision making that includes a physician recommendation. Moreover, there are independent ethical reasons for arguing that physician recommendations enhance rather than detract from shared decision making.
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Affiliation(s)
- Micah T Prochaska
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Daniel P Sulmasy
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA; MacLean Center for Clinical and Medical Ethics, The University of Chicago, Chicago, Illinois, USA; The Divinity School, The University of Chicago, Chicago, Illinois, USA.
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Ratliff M, Neumann JO. [Decision conflicts with relatives in the intensive care unit]. Med Klin Intensivmed Notfmed 2015; 111:638-643. [PMID: 26514821 DOI: 10.1007/s00063-015-0109-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/25/2015] [Accepted: 08/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND If medicine is coming close to its limits conflicts sometimes occur. Most conflicts in the intensive care unit (ICU) involve the medical team and patients' relatives. In particular decisions about withholding and withdrawing life-sustaining therapy lead to conflicts. Decisions about limiting life-sustaining treatment are burdened by conflicts and put an enormous strain particularly on relatives. AIM Illustration of currently available studies and existing recommendations on how to manage potentially conflict-laden decision-finding discussions on the ICU are presented. MATERIAL AND METHODS This article is based on a selective literature research in the PubMed database. RESULTS Studies have been carried out to evaluate posttraumatic stress disorders in relatives who were involved in life-limiting treatment decisions. Conflicts on the ICU put an emotional strain on relatives. Evidence-based recommendations are available regarding physicians' attitudes during discussions about therapy decisions, communication style and other contextual factors. Study results show that the emotional stress level relatives have to endure can be reduced if conversations between patients' families and the clinical personnel were conducted according to these recommendations. The involvement of a clinical ethics committee can prevent conflicts and has been shown to have no impact on the mortality rate but does decrease the time life-sustaining measures were unsuccessfully pursued. CONCLUSION To prevent conflicts between the medical personnel and patients' relatives on the ICU, a timely, congruent and empathic conversation style in an appropriate, quiet environment is essential. Consultation with clinical ethics committees is recommended to de-escalate disputes.
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Affiliation(s)
- M Ratliff
- Neurochirurgische Klinik Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
| | - J-O Neumann
- Neurochirurgische Klinik Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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ICU family communication and health care professionals: A qualitative analysis of perspectives. Intensive Crit Care Nurs 2015; 31:315-21. [DOI: 10.1016/j.iccn.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/09/2015] [Accepted: 02/24/2015] [Indexed: 11/19/2022]
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Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties. Crit Care Med 2015; 43:1731-44. [PMID: 25821917 DOI: 10.1097/ccm.0000000000000980] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. DATA SOURCES We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. STUDY SELECTION Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. DATA EXTRACTION Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. DATA SYNTHESIS The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. CONCLUSIONS Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.
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Ho R, Chantagul N. Support for voluntary and nonvoluntary euthanasia: what roles do conditions of suffering and the identity of the terminally ill play? OMEGA-JOURNAL OF DEATH AND DYING 2015; 70:251-77. [PMID: 26036055 DOI: 10.1177/0030222815568958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the level of support for voluntary and nonvoluntary euthanasia under three conditions of suffering (pain; debilitated nature of the body; burden on the family) experienced by oneself, a significant other, and a person in general. The sample consisted of 1,897 Thai adults (719 males, 1,178 females) who voluntarily filled in the study's questionnaire. Initial multivariate analysis of variance indicated significant group (oneself, significant other, person in general) differences in level of support for voluntary and nonvoluntary euthanasia and under the three conditions of suffering. Multigroup path analysis conducted on the posited euthanasia model showed that the three conditions of suffering exerted differential direct and indirect influences on the support of voluntary and nonvoluntary euthanasia as a function of the identity of the person for whom euthanasia was being considered. The implications of these findings are discussed.
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Lendon JP, Ahluwalia SC, Walling AM, Lorenz KA, Oluwatola OA, Anhang Price R, Quigley D, Teno JM. Measuring Experience With End-of-Life Care: A Systematic Literature Review. J Pain Symptom Manage 2015; 49:904-15.e1-3. [PMID: 25543110 PMCID: PMC5063029 DOI: 10.1016/j.jpainsymman.2014.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/27/2014] [Accepted: 10/22/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. OBJECTIVES To evaluate the instruments currently in use to inform next steps for research and policy in this area. METHODS We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. RESULTS We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. CONCLUSION This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.
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Affiliation(s)
| | | | - Anne M Walling
- VA Greater Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Karl A Lorenz
- VA Greater Los Angeles, Los Angeles, California, USA
| | | | | | | | - Joan M Teno
- Brown University, Providence, Rhode Island, USA
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Assessment of satisfaction with care among family members of survivors in a neuroscience intensive care unit. J Neurosci Nurs 2014; 46:106-16. [PMID: 24556658 DOI: 10.1097/jnn.0000000000000038] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many prior nursing studies regarding family members specifically of neuroscience intensive care unit (neuro-ICU) patients have focused on identifying their primary needs. A concept related to identifying these needs and assessing whether they have been met is determining whether families explicitly report satisfaction with the care that both they and their loved ones have received. The objective of this study was to explore family satisfaction with care in an academic neuro-ICU and compare results with concurrent data from the same hospital's medical ICU (MICU). Over 38 days, we administered the Family Satisfaction-ICU instrument to neuro-ICU and MICU patients' families at the time of ICU discharge. Those whose loved ones passed away during ICU admission were excluded. When asked about the respect and compassion that they received from staff, 76.3% (95% CI [66.5, 86.1]) of neuro-ICU families were completely satisfied, as opposed to 92.7% in the MICU (95% CI [84.4, 101.0], p = .04). Respondents were less likely to be completely satisfied with the courtesy of staff if they reported participation in zero formal family meeting. Less than 60% of neuro-ICU families were completely satisfied by (1) frequency of physician communication, (2) inclusion and (3) support during decision making, and (4) control over the care of their loved ones. Parents of patients were more likely than other relatives to feel very included and supported in the decision-making process. Future studies may focus on evaluating strategies for neuro-ICU nurses and physicians to provide better decision-making support and to implement more frequent family meetings even for those patients who may not seem medically or socially complicated to the team. Determining satisfaction with care for those families whose loved ones passed away during their neuro-ICU admission is another potential avenue for future investigation.
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Hernández-Tejedor A, Martín Delgado MC, Cabré Pericas L, Algora Weber A. Limitation of life-sustaining treatment in patients with prolonged admission to the ICU. Current situation in Spain as seen from the EPIPUSE Study. Med Intensiva 2014; 39:395-404. [PMID: 25241266 DOI: 10.1016/j.medin.2014.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/17/2014] [Accepted: 06/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Limitation of life-sustaining treatment (LLST) is a recommended practice in certain circumstances. Limitation practices are varied, and their application differs from one center to another. The present study evaluates the current situation of LLST practices in patients with prolonged admission to the ICU who suffer worsening of their condition. DESIGN A prospective, observational cohort study was carried out. SETTING Seventy-five Spanish ICUs. PATIENTS A total of 589 patients suffering 777 complications or adverse events with organ function impairment after day 7 of admission, during a three-month recruitment period. MAIN VARIABLES OF INTEREST The timing of limitation, the subject proposing LLST, the degree of agreement within the team, the influence of LLST upon the doctor-patient-family relationship, and the way in which LLST is implemented. RESULTS LLST was proposed in 34.3% of the patients presenting prolonged admission to the ICU with severe complications. The incidence was higher in patients with moderate to severe lung disease, cancer, immunosuppressive treatment or dependence for basic activities of daily living. LLST was finally implemented in 97% of the cases in which it was proposed. The decision within the medical team was unanimous in 87.9% of the cases. The doctor-patient-family relationship usually does not change or even improves in this situation. CONCLUSION LLST in ICUs is usually carried out under unanimous decision of the medical team, is performed more frequently in patients with severe comorbidity, and usually does not have a negative impact upon the relationship with the patients and their families.
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Affiliation(s)
- A Hernández-Tejedor
- Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - M C Martín Delgado
- Unidad de Cuidados Intensivos, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - L Cabré Pericas
- Unidad de Cuidados Intensivos, Hospital de Barcelona SCIAS, Barcelona, España
| | - A Algora Weber
- Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Souza TLD, Barilli SLS, Azeredo NSGD. Perspective of family members regarding the process of dying in the intensive care unit. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014002200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the perspective of family members on end-of-life in the Intensive Care Unit. This is an exploratory descriptive study with a qualitative approach. Semi-structured individual interviews were held with eight family members of terminally-ill patients receiving inpatient treatment in an Intensive Care Unit in a public hospital in Porto Alegre, in the State of Rio Grande do Sul . The method of content analysis was used for data analysis. During the process of dying, it was evident that the feelings experienced by the family members were diverse, including distress, insecurity, anger, guilt and missing the loved one. Also demonstrated by the family members were the importance of being with the loved person, and the desire to establish a link between the team-patient-family
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Yoo JS, Lee J, Chang SJ. Family Experiences in End-of-Life Care: A Literature Review. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 2:223-34. [PMID: 25029960 DOI: 10.1016/s1976-1317(09)60004-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 09/12/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to summarize and analyze families' experiences of end-of-life care by conducting a systematic review of peer reviewed journals both in Korea and abroad. BACKGROUND Families play an increasingly important role in care and medical treatment, acting as caregivers or decision makers rather than just being passive observers. It is necessary to understand the experiences of family members in order to provide appropriate care for them. METHODS A systematic search of the literature was performed using the Cumulative Index for Nursing and Allied Health Literature (CINAHL) and the Korea Education & Research Information Service (KERIS) for the period of January 1990 through to December 2006. A total of 35 studies met the inclusion criteria. RESULTS Seventeen studies used a quantitative design, while 18 studies used qualitative methods. Quantitative studies reported that the family's quality of life was relatively low when the patient was in need of high medical/nursing services. The perceived burden levels were moderately high, and depression levels were high among family caregivers. Various concepts emerged from the 18 qualitative studies, including psychological issues, physical problems, burdens, needs and interpersonal relationships. CONCLUSION This study found that most previous research findings were focused on negative and neutral experiences. A few studies identified positive experiences. Based on the study results, we suggest that nurses need to be more aware of the experiences of patients' families and their potential needs.
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Affiliation(s)
- Ji-Soo Yoo
- Professor, Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - JuHee Lee
- Assistant Professor, Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Soo Jung Chang
- Ph.D. candidate, Department of Nursing, Graduate school, Yonsei University
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A multifaceted intervention to improve compliance with process measures for ICU clinician communication with ICU patients and families. Crit Care Med 2013; 41:2275-83. [PMID: 24060769 DOI: 10.1097/ccm.0b013e3182982671] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE Despite recommendations supporting the importance of clinician-family communication in the ICU, this communication is often rated as suboptimal in frequency and quality. We employed a multifaceted behavioral-change intervention to improve communication between families and clinicians in a statewide collaboration of ICUs. OBJECTIVES Our primary objective was to examine whether the intervention resulted in increased compliance with process measures that targeted clinician-family communication. As secondary objectives, we examined the ICU-level characteristics that might be associated with increased compliance (open vs closed, teaching vs nonteaching, and medical vs medical-surgical vs surgical) and patient-specific outcomes (mortality, length of stay). METHODS The intervention was a multifaceted quality improvement approach targeting process measures adapted from the Institute of Health Improvement and combined into two "bundles" to be completed either 24 or 72 hours after ICU admission. MEASUREMENTS AND MAIN RESULTS Significant increases were seen in full compliance for both day 1 and day 3 process measures. Day 1 compliance improved from 10.7% to 83.8% after 21 months of intervention (p<0.001). Day 3 compliance improved from 1.6% to 28.8% (p<0.001). Improvements in compliance varied across ICU type with less improvement in open, nonteaching, and mixed medical-surgical ICUs. Patient-specific outcome measures were unchanged, although there was a small increase in patients discharged from ICU to inpatient hospice (p=0.002). CONCLUSIONS We found that a multifaceted intervention in a statewide ICU collaborative improved compliance with specific process measures targeting communication with family members. The effect of the intervention varied by ICU type.
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Levy MM, De Backer D. Re-visiting visiting hours. Intensive Care Med 2013; 39:2223-5. [PMID: 24085018 DOI: 10.1007/s00134-013-3119-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
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Lawson B, Van Aarsen K, Burge F. Challenges and strategies in the administration of a population based mortality follow-back survey design. BMC Palliat Care 2013; 12:28. [PMID: 23919380 PMCID: PMC3750367 DOI: 10.1186/1472-684x-12-28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/02/2013] [Indexed: 11/22/2022] Open
Abstract
Population-based mortality follow-back survey designs have been used to collect information concerning end-of-life care from bereaved family members in several countries. In Canada, this design was recently employed to gather population-based information about the end-of-life care experience among adults in Nova Scotia as perceived by the decedent's family. In this article we describe challenges that emerged during the implementation of the study design and discuss resolutions strategies to help overcome them. Challenges encountered included the inability to directly contact potential participants, difficulties ascertaining eligibility, mailing strategy complications and the overall effect of these issues on response rate and subsequent sample size. Although not all challenges were amenable to resolution, strategies implemented proved beneficial to the overall process and resulted in surpassing the targeted sample size. The inability to directly contact potential participants is an increasing reality and limitations associated with this process best acknowledged during study development. Future studies should also consider addressing participant concerns pertaining to their eligibility and use of a more cost effective mailing strategy.
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Affiliation(s)
- Beverley Lawson
- Department of Family Medicine, Dalhousie University, 5909 Veterans Memorial Lane, Abbie J, Lane Building, 8th Fl, Halifax, NS B3H 2E2, Canada.
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Wiegand DL, Grant MS, Cheon J, Gergis MA. Family-Centered End-of-Life Care in the ICU. J Gerontol Nurs 2013; 39:60-8. [DOI: 10.3928/00989134-20130530-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/10/2013] [Indexed: 11/20/2022]
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Schleyer AM, Curtis JR. Family satisfaction in the ICU: why should ICU clinicians care? Intensive Care Med 2013; 39:1143-5. [PMID: 23612761 DOI: 10.1007/s00134-013-2939-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
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Kross EK, Nielsen EL, Curtis JR, Engelberg RA. Survey burden for family members surveyed about end-of-life care in the intensive care unit. J Pain Symptom Manage 2012; 44:671-80. [PMID: 22762964 PMCID: PMC3488148 DOI: 10.1016/j.jpainsymman.2011.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/10/2011] [Accepted: 11/13/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Family surveys are an important source of information about quality of end-of-life care in the intensive care unit (ICU). The burden associated with completing such surveys is not well studied. OBJECTIVES 1) To assess the predictors of burden that families report with completing surveys for patients who died in the ICU and 2) to examine associations between quality-of-care ratings and survey burden. METHODS Data were collected from 14 hospitals as part of a cluster randomized trial to integrate palliative care into the ICU. Survey questions included demographics, quality of dying, satisfaction with care, and overall level of burden associated with survey completion. Patient characteristics were identified from chart abstraction and death certificates. Multivariable linear regression with robust SEs was used to examine associations between survey burden, subject characteristics, and family ratings of quality of care. RESULTS Of the families surveyed, 62% rated the survey to be no or low burden. Family members of older patients reported less survey burden (P = 0.016), and those who lived with the patient reported higher survey burden (P = 0.043). Family members reporting lower ratings of satisfaction with care and quality of dying reported higher survey burden (P < 0.001). CONCLUSION Most families reported no to low burden. Family members who live with their loved one are particularly vulnerable to survey burden and those of older patients report less burden. The association between low quality-of-care ratings and survey burden suggests that the response bias in this type of research is toward overestimating quality of care.
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Affiliation(s)
- Erin K Kross
- Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
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