title: End-of-life care in the intensive care unit: a patient-based questionnaire of intensive care unit staff perception and relatives' psychological response.
abstract: BACKGROUND
  Communication is a hallmark of end-of-life care in the intensive care unit. It may influence the impact of end-of-life care on patients' relatives. We aimed to assess end-of-life care and communication from the perspective of intensive care unit staff and relate it to relatives' psychological symptoms.
  
  
  METHODS
  Prospective observational study based on consecutive patients with severe sepsis receiving end-of-life care; trial registration NCT01247792.
  
  
  METHODS
  Four interdisciplinary intensive care units of a German University hospital. Responsible health personnel (attendings, residents and nurses) were questioned on the day of the first end-of-life decision (to withdraw or withhold life-supporting therapies) and after patients had died or were discharged. Relatives were interviewed by phone after 90 days.
  
  
  RESULTS
  Overall, 145 patients, 610 caregiver responses (92% response) and 84 relative interviews (70% response) were analysed. Most (86%) end-of-life decisions were initiated by attendings and only 2% by nurses; 41% of nurses did not know enough about end-of-life decisions to communicate with relatives. Discomfort with end-of-life decisions was low. Relatives reported high satisfaction with decision-making and care, 87% thought their degree of involvement had been just right. However, 51%, 48% or 33% of relatives had symptoms of post-traumatic stress disorder, anxiety or depression, respectively. Predictors for depression and post-traumatic stress disorder were patient age and relatives' gender. Relatives' satisfaction with medical care and communication predicted less anxiety (p = 0.025).
  
  
  CONCLUSIONS
  Communication should be improved within the intensive care unit caregiver team to strengthen the involvement of nurses in end-of-life care. Improved communication between caregivers and the family might lessen relatives' long-term anxiety.
authors: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors: Christiane S
authors: CS
authors: Hartog
authors: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
authors: Daniel
authors: D
authors: Schwarzkopf
authors: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors: Niels C
authors: NC
authors: Riedemann
authors: Department of Internal Medicine I, Jena University Hospital, Jena, Germany.
authors: Ruediger
authors: R
authors: Pfeifer
authors: Department of Neurology, Jena University Hospital, Jena, Germany.
authors: Albrecht
authors: A
authors: Guenther
authors: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors: Kati
authors: K
authors: Egerland
authors: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors: Charles L
authors: CL
authors: Sprung
authors: Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors: Heike
authors: H
authors: Hoyer
authors: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany Department of General Medicine, Jena University Hospital, Jena, Germany.
authors: Jochen
authors: J
authors: Gensichen
authors: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany Konrad.Reinhart@med.uni-jena.de.
authors: Konrad
authors: K
authors: Reinhart
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D003142:Communication; D003258:Consumer Behavior; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D011368:Professional-Family Relations; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*
keywords: Palliative care; attitude of health personnel; intensive care units; resuscitation orders; sepsis