title: Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review.
abstract: BACKGROUND
  Family satisfaction with end-of-life care in the ICU has not previously been systematically reviewed. Our objective was to perform a review, synthesizing published data identifying factors associated with family satisfaction with end-of-life care in critically ill adult populations.
  
  
  METHODS
  The following electronic databases were searched: MEDLINE (Medical Literature Analysis and Retrieval System Online), MEDLINE Updated, EMBASE (Excerpta Medical Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo, and PubMed. Two authors reviewed retrieved titles and abstracts. Studies describing nonadult and non-ICU populations or not addressing end-of-life care, family satisfaction, or factors affecting satisfaction were excluded. The remaining articles underwent full review and data extraction by two authors. Quality was assessed using a checklist based on the recommendations of the Consolidated Standards for Reporting Trials group.
  
  
  RESULTS
  The search yielded 1,072 articles, with 23 articles describing 14 studies meeting inclusion criteria. All studies obtained satisfaction data from family members via surveys and structured interviews. Specific communication strategies increasing satisfaction included: expressions of empathy, nonabandonment, and assurances of comfort and provision of written information. Additionally, support for shared decision-making, family presence at time of death, and specific patient-care measures such as extubation before death were associated with increased satisfaction.
  
  
  CONCLUSIONS
  Good-quality communication, support for shared decision-making, and specific patient-care measures were associated with increased satisfaction with end-of-life care. Assessing the family's desire to participate in shared decision-making may also be an important factor. Few interventions increased satisfaction. Future research is needed to further define optimal communication strategies, understand effective integration of palliative care into the ICU, and define significant score changes in survey instruments.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Indiana University Health, Indianapolis, IN. Electronic address: ljhinkle@iu.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Hinkle
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, Indiana University Health, Indianapolis, IN; Fairbanks Center for Medical Ethics, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Gabriel T
authors.initials: GT
authors.lastname: Bosslet
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Fairbanks Center for Medical Ethics, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Alexia M
authors.initials: AM
authors.lastname: Torke
mesh_terms: D003657:Decision Making; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units; D010358:Patient Participation; D010549:Personal Satisfaction; D013727:Terminal Care / Q000379:methods*