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Quality of dying and death in intensive care units: family satisfaction
  1. Fur-Hsing Wen1,
  2. Ming Chu Chiang2,
  3. Chung-Chi Huang3,4,
  4. Tsung-Hui Hu5,
  5. Wen-Chi Chou6,7,
  6. Li-Pang Chuang3 and
  7. Siew Tzuh Tang8,9
  1. 1Department of International Business, Soochow University - Downtown Campus, Taipei, Taiwan
  2. 2Department of Nursing, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
  3. 3Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  4. 4Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
  5. 5Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
  6. 6Department of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  7. 7School of Medicine, Chang Gung University, Taoyuan, Taiwan
  8. 8School of Nursing, Chang Gung University College of Medicine, Taoyuan, Taiwan
  9. 9Division of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
  1. Correspondence to Dr Siew Tzuh Tang, School of Nursing, Chang Gung University College of Medicine, Taoyuan 333, Taiwan; sttang{at}mail.cgu.edu.tw

Abstract

Objective This cohort study identified patterns/classes of surrogates’ assessment of their relative’s quality of dying and death (QODD) and to evaluate their associations with family satisfaction with intensive care unit (ICU) care.

Methods We identified QODD classes through latent class analysis of the frequency component of the QODD questionnaire and examined their differences in summary questions on the QODD and scores of the Family Satisfaction in the ICU questionnaire among 309 bereaved surrogates of ICU decedents.

Results Four distinct classes (prevalence) were identified: high (41.3%), moderate (20.1%), poor-to-uncertain (21.7%) and worst (16.9%) QODD classes. Characteristics differentiate these QODD classes including physical symptom control, emotional preparedness for death, and amount of life-sustaining treatments (LSTs) received. Patients in the high QODD class had optimal physical symptom control, moderate-to-sufficient emotional preparedness for death and few LSTs received. Patients in the moderate QODD class had adequate physical symptom control, moderate-to-sufficient emotional preparedness for death and the least LSTs received. Patients in the poor-to-uncertain QODD class had inadequate physical symptom control, insufficient-uncertain emotional preparedness for death and some LSTs received. Patients in the worst QODD class had poorest physical symptom control, insufficient-to-moderate emotional preparedness for death and substantial LSTs received. Bereaved surrogates in the worst QODD class scored significantly lower in evaluations of the patient’s overall QODD, and satisfaction with ICU care and decision-making process than those in the other classes.

Conclusions The identified distinct QODD classes offer potential actionable direction for improving quality of end-of-life ICU care.

  • End of life care
  • Family management
  • Terminal care
  • Bereavement
  • Psychological care

Data availability statement

Data may be obtained from a third party and are not publicly available. The sharing of anonymised data from this study is restricted due to ethical and legal constrictions. Data contains sensitive personal health information, which is protected under The Personal Data Protection Act, thus making all data requests subject to Institutional Review Board (IRB) approval. Per Chang Gung Memorial Hospital (CGMH) IRB, the data that support the findings of this study are restricted for transmission to those in the primary investigative team. Data sharing with investigators outside the team requires IRB approval. All requests for anonymised data will be reviewed by the research team and then submitted to the CGMH IRB for approval.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The sharing of anonymised data from this study is restricted due to ethical and legal constrictions. Data contains sensitive personal health information, which is protected under The Personal Data Protection Act, thus making all data requests subject to Institutional Review Board (IRB) approval. Per Chang Gung Memorial Hospital (CGMH) IRB, the data that support the findings of this study are restricted for transmission to those in the primary investigative team. Data sharing with investigators outside the team requires IRB approval. All requests for anonymised data will be reviewed by the research team and then submitted to the CGMH IRB for approval.

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Footnotes

  • F-HW and MCC contributed equally.

  • Contributors F-HW and MCC had equal contribution. F-HW, MCC, T-HH, C-CH, W-CC, L-PC and STT contributed substantially to the study conception and design. T-HH, MCC, C-CH, W-CC, L-PC contributed by providing study patients. T-HH, MCC, C-CH, W-CC, L-PC and STT contributed to collection and/or assembly of data. F-HW, MCC, T-HH, C-CH, W-CC, L-PC and STT contributed to data analysis and interpretation. F-HW, MCC, T-HH, C-CH, W-CC, L-PC and STT contributed to the writing and final approval of the manuscript. The corresponding author (STT) takes responsibility for the content of the manuscript, has full access to all of the data in the study, and is responsible for the integrity of the data, the accuracy of the data analysis, including and especially any adverse effects.

  • Funding National Health Research Institutes (NHRI-EX110-10704PI) with partial support from Ministry of Science and Technology (MOST 108-2314-B-182-061-MY3) and Chang Gung Memorial Hospital (BMRP888).

  • Disclaimer No funding sources had any role in designing and conducting the study; collecting, managing, analyzing, and interpreting the data; or preparing, reviewing, or approving the article.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.