Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, Republic of China.
College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.
J Palliat Med. 2022 Mar;25(3):368-375. doi: 10.1089/jpm.2021.0304. Epub 2021 Sep 1.
Evidence linking process-based, high-quality end-of-life (EOL) care indicators to family satisfaction with EOL care in intensive care units (ICUs) remains limited. This study aimed to fill this gap. For this exploratory, prospective, longitudinal observational study, 278 family members were consecutively recruited from medical ICUs at two medical centers in Taiwan. Family satisfaction with ICU care was surveyed in the first month after patient death using the Family Satisfaction in the ICU questionnaire (FS-ICU). Associations between FS-ICU scores and process-based quality indicators collected over the patient's ICU stay were examined using generalized estimating equations. Documentation of process-based indicators of high-quality EOL care was generally associated with higher scores for both the FS-ICU Care and FS-ICU Decision-Making domains. Higher family satisfaction with ICU care was significantly associated with physician-family prognostic communication ( [95% confidence interval (CI)]: 3.558 [2.963 to 4.154]), a do-not-resuscitate (DNR) order in place at death (23.095 [17.410 to 28.779]), and death without cardiopulmonary resuscitation (CPR) (13.325 [11.685 to 14.965]). Family members' satisfaction with decision making was positively associated with documentation of social worker involvement (4.767 [0.663 to 8.872]), a DNR order issued (10.499 [0.223 to 20.776]), and withdrawal of life-sustaining treatments (LSTs) before death (2.252 [1.834 to 2.670]). EOL care processes are associated with family satisfaction with EOL care in ICUs. Bereaved family members' satisfaction with EOL care in ICUs may be improved by promoting physician-family prognostic communication and psychosocial support, facilitating a DNR order and death without CPR, and withdrawing LSTs for patients dying in ICUs.
将基于过程的高质量终末期（EOL）护理指标与重症监护病房（ICU）中家庭对 EOL 护理的满意度联系起来的证据仍然有限。本研究旨在填补这一空白。
这项探索性、前瞻性、纵向观察研究连续招募了来自台湾两家医疗中心的 278 名 ICU 患者的家属。在患者死亡后第一个月，使用 ICU 家庭满意度问卷（FS-ICU）调查家庭对 ICU 护理的满意度。使用广义估计方程检查 ICU 住院期间收集的基于过程的 EOL 护理质量指标与 FS-ICU 评分之间的关联。
EOL 护理高质量的基于过程指标的记录通常与 FS-ICU 护理和 FS-ICU 决策领域的评分较高相关。家庭对 ICU 护理的满意度与医生与家属的预后沟通（[95%置信区间（CI）]：3.558 [2.963 至 4.154]）、死亡时的 DNR 医嘱（23.095 [17.410 至 28.779]）和无心肺复苏（CPR）的死亡（13.325 [11.685 至 14.965]）显著相关。家属对决策的满意度与社会工作者参与的记录（4.767 [0.663 至 8.872]）、发布的 DNR 医嘱（10.499 [0.223 至 20.776]）和在死亡前停止生命支持治疗（LSTs）（2.252 [1.834 至 2.670]）呈正相关。
EOL 护理过程与 ICU 中家庭对 EOL 护理的满意度相关。通过促进医生与家属的预后沟通和社会心理支持、促进 DNR 医嘱和无 CPR 的死亡以及为 ICU 中死亡的患者停止 LSTs，可以提高 ICU 中 EOL 护理的满意度。
