title: Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.
abstract: OBJECTIVE
  To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity.
  
  
  METHODS
  Descriptive observational study.
  
  
  METHODS
  Five intensive care units.
  
  
  METHODS
  One hundred sixteen family surrogate decisionmakers of long-stay intensive care unit patients who participated in an intensive communication system that aimed to provide weekly meetings with family decisionmakers. The structure of each meeting was to address medical update, patient preferences, treatment plan, and milestones for evaluating the treatment plan.
  
  
  METHODS
  None.
  
  
  RESULTS
  We audiotaped initial family meetings for 116 family decisionmakers for a total of 180 meetings. On average, meetings were 24 mins long with a majority of time being devoted to nonemotional speech and little (12%) spent discussing patient preferences. Quality of life was discussed in 45% and treatment limitation in 23% of all meetings. Quality-of-life discussions were more likely to occur when patients were admitted to a medical intensive care unit (odds ratio [OR] 5.9; p = .005), have a family decisionmaker who is a spouse (OR 9.4; p = .0001), were older (OR 1.04; p = 01), have a shorter length of stay (OR 0.93; p = .001), and have a family decisionmaker who was a spouse (OR 5.1; p = .002). For those with a treatment limitation discussion, 67% had a do-not-resuscitate order, 40% were admitted to a medical intensive care unit, 56% had a family decisionmaker who had been their caregiver, and 48% of their family decisionmakers were their children.
  
  
  CONCLUSIONS
  To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. SLD4@case.edu
authors.forename: Sara L
authors.initials: SL
authors.lastname: Douglas
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Daly
authors.forename: Amy R
authors.initials: AR
authors.lastname: Lipson
mesh_terms: D003142:Communication; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008318:Malpractice; D020380:Needs Assessment; D016017:Odds Ratio; D010347:Patient Care Planning / Q000458:organization & administration*; D011368:Professional-Family Relations; D011788:Quality of Life; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States