Quality of dying in the ICU: ratings by family members.
OBJECTIVE
To explore the quality of the dying experience and associations to higher quality ratings for people who died in an ICU.


METHODS
Retrospective study using medical record review and surveys of family members with the Quality of Dying and Death (QODD) instrument.


METHODS
Four ICUs affiliated with a university and a Veterans Affairs Medical Center.


METHODS
Ninety-four family members of 38 ICU decedents.


RESULTS
We explored associations between components of the ICU experience and the overall rating of the quality of the dying experience. Overall, family members reported that symptoms were poorly controlled: pain under control most or all of the time in 47%, and breathing comfortably most or all of the time in 3% of patients. Families expressed a moderate and variable view of the quality of dying resulting in an overall ICU QODD score of 60 +/- 14 (on a scale of 0 to 100) [mean +/- SD]. Higher ICU QODD scores were associated with control of pain (r = 0.42, p = 0.009), control of events (r = 0.62, p < 0.001), a "preparation for death" aspect of the dying experience--feeling at peace with dying (r = 0.69, p < 0.001), and a "whole-person concern"--keeping one's dignity and self-respect (r = 0.50, p < 0.001).


CONCLUSIONS
After adjusting for symptom and personal care scores, certain whole-person and preparation-for-death aspects of the dying process, and not aggressiveness of end-of-life care, remained the most associated to quality ratings. While future research should explore the important predictors of quality of dying in the ICU, this study suggests that care at the end of life in the ICU include not only managing pain, but also supporting dignity, respect, and peace, and maximizing patient control.
Oregon Health & Science University and Portland Veterans' Affairs Medical Center, Portland, OR, USA. Richard.Mularski@med.va.gov
Richard A
RA
Mularski
Carlton E
CE
Heine
Molly L
ML
Osborne
Linda
L
Ganzini
J Randall
JR
Curtis
D000328:Adult; D001293:Attitude to Death; D003643:Death; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care