Medical Intensive Care, University Hospital of Poitiers, Poitiers, France.
INSERM CIC 1402 (ALIVE group), Poitiers University, Poitiers, France.
Crit Care. 2020 Aug 25;24(1):521. doi: 10.1186/s13054-020-03191-z.
As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient's and/or the relatives' experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study.
Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort.
Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside.
We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
随着重症监护病房（ICU）死亡人数的增加，越来越多的研究旨在描述、理解和改善该环境下的临终关怀。这些研究大多集中在患者和/或家属的体验上。我们的研究旨在使用混合方法开发一种评估 ICU 死亡患者的医生和护士体验的工具，并在一项前瞻性多中心研究中进行验证。
41 个 ICU 中死亡患者的医生和护士在患者死亡后 24 小时内完成了工作压力和 CAESAR 问卷。使用两个数据集进行心理测量验证：学习队列和可靠性队列。
在主要队列中的 475 名患者中，分析了 398 名护士和 417 名医生的评分。护士的总体评分较高[62/75（59；66）]，医生的评分也较高[64/75（61；68）]。与 CAESAR-护士评分较高相关的因素包括与医生无冲突、与医生共同处理疼痛控制、在床边向家属透露死亡、未进行侵入性治疗。根据工作压力工具评估，低决策控制与较低的 CAESAR 评分相关（61（58；65）与 63（60；67），p=0.002）。与 CAESAR-医生评分较高相关的因素包括为家属提供信息的专用房间、护士和医生共同提供信息、系统地向家属告知 EOL 决策、在实施 EOL 决策时护士的参与以及开放探视。当做出停止或撤回治疗的决定、未进行心肺复苏以及在床边向家属透露死亡时，评分也较高。
我们描述并验证了一种新的评估 ICU 中参与 EOL 的医生和护士体验的工具。这项研究表明了改善实践的重要领域。
