title: Exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit: a mixed methods study.
abstract: OBJECTIVE
  Improving the quality of end-of-life (EOL) care in critical care settings is a high priority. Patients with advanced chronic obstructive pulmonary disease (COPD) are frequently admitted to and die in critical care units. To date, there has been little research examining the quality of EOL care for this unique subpopulation of critical care patients.
  
  
  OBJECTIVE
  The aims of this study were (a) to examine critical care clinician perspectives on the quality of dying of patients with COPD and (b) to compare nurse ratings of the quality of dying and death between patients with COPD with those who died from other illnesses in critical care settings.
  
  
  METHODS
  A sequential mixed method design was used. Three focus groups provided data describing the EOL care provided to patients with COPD dying in the intensive care unit (ICU). Nurses caring for patients who died in the ICU completed a previously validated, cross-sectional survey (Quality of Dying and Death) rating the quality of dying for 103 patients.
  
  
  METHODS
  Thematic analysis was used to analyse the focus group data. Total and item scores for 34 patients who had died in the ICU with COPD were compared with those for 69 patients who died from other causes.
  
  
  RESULTS
  Three primary themes emerged from the qualitative data are as follows: managing difficult symptoms, questioning the appropriateness of care and establishing care priorities. Ratings for the quality of dying were significantly lower for patients with COPD than for those who died from other causes on several survey items, including dyspnoea, anxiety and the belief that the patient had been kept alive too long. The qualitative data allowed for in-depth explication of the survey results.
  
  
  CONCLUSIONS
  Attention to the management of dyspnoea, anxiety and treatment decision-making are priority concerns when providing EOL care in the ICU to patients with COPD.
authors.affiliation: College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. donna.goodridge@usask.ca
authors.forename: Donna
authors.initials: D
authors.lastname: Goodridge
authors.forename: Wendy
authors.initials: W
authors.lastname: Duggleby
authors.forename: John
authors.initials: J
authors.lastname: Gjevre
authors.forename: Donna
authors.initials: D
authors.lastname: Rennie
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D001007:Anxiety / Q000517:prevention & control; D002170:Canada; D004417:Dyspnea / Q000451:nursing; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing*; D011787:Quality of Health Care; D013727:Terminal Care