Chest
Clinical Investigations in Critical CareQuality of Dying in the ICU: Ratings by Family Members
Section snippets
Study Design and Sampling Strategy
We performed interviews with multiple family members of patients who died in an ICU to measure the quality of the dying experience. We enrolled family members of patients who died in any of four ICUs of either a university teaching hospital or an academic Veterans Affairs Medical Center (VA). All deaths during the calendar year 2000 were reviewed for inclusion. Inclusion criteria required that the decedents were at least 21 years old at the time of death and died in the ICU after a stay of at
Recruitment and Patient/Family Characteristics
We identified 365 ICU deaths at the study sites during the study year. One hundred eight decedents met the inclusion criteria, and families of 38% of the eligible decedents were enrolled; details on enrollment were reported in a prior publication.29 The most common reasons cited for nonparticipation of family members were family members feeling too emotional (32%) or only one family member willing to participate (24%). Ninety-four family members completed the interview. Sixty-eight percent of
Discussion
Family members reported a moderate and variable quality of dying and death in the ICU in this study, resulting in an average ICU QODD score of 60 points out of 100 (SD, 14). This average score and SD were comparable to that reported in a prior study23 of all deaths in one community, where the total score was 67 (SD, 15). Our analysis confirmed the importance of pain control for quality dying in the ICU. Consistent with prior studies1113151617 of hospitalized dying, symptoms were infrequently
Conclusion
In conclusion, we found that family members perceive a moderate and variable quality of dying and death in the ICU. The aspects associated with higher family ratings of the quality dying in the ICU, included pain control, control of events, feeling at peace with dying, and keeping one’s dignity and self-respect. Because of the high prevalence of death in the ICU, continued efforts to understand the experience of dying in the ICU will be important for improving quality of care in the ICU
Five Additional ICU Questions Added to the QODD Instrument
How well was X (name) 1 month before her/his death?30 0 = no evidence of disease; no restrictions; 1 = some signs or symptoms of disease, ambulatory, able to carry out light housework or office work; 2 = able to care for most needs of self, unable to carry out work activities, up and about more than half of waking hours; 3 = disabled, limited self care, confined to bed or chair more than half of waking hours, requires special care and assistance; 4 = completely disabled requiring hospital-like
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This work was performed at Oregon Health & Science University and Portland Veterans Affairs Medical Center.
This study was supported by grants from the Northwest Health Foundation, the American Lung Association of Oregon, and the General Clinical Research Center of Oregon Health & Science University by National Institute of Health grant PHS 5 M01 RR00334.