Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC.
Intensive Crit Care Nurs. 2022 Aug;71:103243. doi: 10.1016/j.iccn.2022.103243. Epub 2022 Apr 6.
Family satisfaction with end-of-life care in the intensive care unit constitutes an important outcome for evaluating end-of-life care quality. Research on this topic focuses on linking end-of-life care processes to family-surrogate satisfaction with the patient's end-of-life care but has seldom examined patient- and family-surrogate-based factors. We aimed to comprehensively and simultaneously examine factors facilitating or deterring family satisfaction with end-of-life care in the intensive care unit from patient- and family-surrogate perspectives.
For this secondary-analysis study, 278 Taiwanese family surrogates were surveyed one-month post-patient death using the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU), which measures care and decision-making. Associations between family satisfaction with end-of-life care and patient and family characteristics, patient disease severity, and length of intensive care stay were examined by multivariate, multilevel linear regression models.
Female family surrogates were more satisfied with patients' end-of-life care than male family surrogates when patients had a higher APACHE II but a lower SOFA score. Adult-child surrogates had lower FS-ICU Care scores than other family surrogates. Higher satisfaction with ICU decision-making was associated with patients' higher APACHE II but lower SOFA scores, longer stay and family socio-demographics, including being unmarried, educational attainment above junior high school and reported financial sufficiency to make ends meet.
Patient disease severity and family-surrogate characteristics are significantly associated with surrogates' satisfaction with patients' end-of-life care in the intensive care unit. Specific interventions should be tailored to the needs of high-risk family surrogates to increase their satisfaction with this care.
家庭对重症监护病房临终关怀的满意度是评估临终关怀质量的一个重要指标。关于这一主题的研究侧重于将临终关怀过程与家庭代理人对患者临终关怀的满意度联系起来，但很少考察患者和家庭代理人的因素。我们的目的是从患者和家庭代理人的角度全面、同时地考察促进或阻碍家庭对重症监护病房临终关怀满意度的因素。
在这项二次分析研究中，我们使用重症监护病房家庭满意度问卷（FS-ICU）对 278 名台湾家庭代理人进行了患者死亡后一个月的调查，该问卷用于测量护理和决策。通过多变量、多层次线性回归模型，考察了家庭对临终关怀的满意度与患者和家庭特征、患者疾病严重程度和重症监护病房住院时间之间的关系。
当患者的 APACHE II 评分较高但 SOFA 评分较低时，女性家庭代理人比男性家庭代理人对患者的临终关怀更满意。成年子女代理人的 FS-ICU 护理评分低于其他家庭代理人。对 ICU 决策的满意度越高，与患者的 APACHE II 评分越高但 SOFA 评分越低、住院时间越长以及家庭社会人口统计学特征有关，包括未婚、受教育程度高于初中和报告有足够的经济能力维持生计。
患者的疾病严重程度和家庭代理人的特征与代理人对重症监护病房患者临终关怀的满意度显著相关。应根据高危家庭代理人的需求定制特定的干预措施，以提高他们对这种护理的满意度。
