"So much of the pain and suffering around end-of-life care, from both the patients' and families' perspectives, relates to the way in which staff communicate with them," said lead author Daren Heyland, MD, MSc, Director of Research, Critical Care Program Kingston General Hospital, Ontario, Canada. "When it becomes apparent that a patient is going to die from his or her critical illness, physicians need to direct more supportive care and compassion, to a greater degree, toward family members."
Researchers from six university-affiliated hospitals in Ontario, Alberta, British Columbia, and Nova Scotia, Canada, documented the experience of patients dying in ICUs from the perspectives of family members. Researchers surveyed family members of nonsurviving patients who had been supported by mechanical ventilation and in the ICU for more than 48 hours. Of the 256 completed surveys, 52 percent of the families rated their satisfaction with overall ICU care as "excellent," 31 percent as "very good," and 10 percent as "good." The majority of respondents believed they were adequately included in the decision-making process (84.2 percent), that they received an appropriate amount of information (88.1 percent), that they had adequate time to have their concerns and questions addressed (73.9 percent), and that they were "very supported" or "supported" by the health care team (87.7 percent). In addition, the majority of family members rated the ease of getting information, their understanding of information, and the honesty and completeness of information provided as excellent. With regard to general patient care, 83.3 percent of families reported that they were "completely" or "very" satisfied with the amount or level of health care that the patient actually received. In the final hours of life, 34.8 percent of respondents reported that the patient was "totally comfortable," while 55.8 percent reported the patient was "very" or "mostly" comfortable. The majority of families considered the symptom management to be "excellent," and most believed that the patient's life was neither prolonged nor shortened unnecessarily.
"Although some of the study findings are limited to Canadian ICUs, the importance of adequate communication, good decision-making, and respect and compassion in quality critical care crosses many settings, borders, and cultures," said Dr. Heyland. "As we learn more about optimal communication and decision-making strategies, we will need educational interventions that will help translate this knowledge into practice in the ICU setting."
Significant correlations were found between satisfaction with end-of-life care and the way in which family members and patients were treated. Specifically, family members who rated the courtesy, compassion, and respect shown to them by ICU staff as excellent, were more than twice as likely to rate their overall ICU experience as completely satisfactory than families who reported the same treatment for the patient. Family members who were completely satisfied with the amount or level of patient care were more likely to be completely satisfied with their overall ICU experience than those families not satisfied with patient care. In addition, family members who rated completeness of information provided by ICU staff as excellent were more likely to be completely satisfied with their overall ICU experience than those families who felt they were less informed.
"As physicians, patient care is our utmost priority. However, it is essential for critical care physicians and staff to recognize the role of the patient's family in decision-making and to establish a supportive hospital environment with open communication, respect, and compassion," said Udaya B. S. Prakash, MD, FCCP, President of the American College of Chest Physicians.
CHEST is a peer-reviewed journal published by the ACCP. It is available on-line each month at www.chestjournal.org. ACCP represents more than 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the United States and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. ACCP's philanthropic arm, The CHEST Foundation, is active in end-of-life care and education.
Additional Contact:
Liza Morris, 202-955-6222
lmorris@spectrumscience.com