Department of International Business, Soochow University - Downtown Campus, Taipei, Taiwan.
Department of Nursing, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan.
BMJ Support Palliat Care. 2024 Jan 8;13(e3):e1217-e1227. doi: 10.1136/spcare-2022-003950.
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.
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.
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.
The identified distinct QODD classes offer potential actionable direction for improving quality of end-of-life ICU care.
本队列研究确定了代理人对其亲属临终和死亡质量（QODD）的评估模式/类别，并评估其与 ICU 护理的家庭满意度之间的关联。
我们通过 QODD 问卷的频率分量进行潜在类别分析，确定了 QODD 类别，并在 ICU 死者的 309 名悲痛代理人中，通过 QODD 摘要问题和 ICU 家庭满意度问卷的分数来检查这些类别的差异。
确定了四个不同的类别（患病率）：高（41.3%）、中（20.1%）、差到不确定（21.7%）和最差（16.9%）的 QODD 类别。这些 QODD 类别的特征包括身体症状控制、对死亡的情感准备和接受生命支持治疗（LST）的数量。高 QODD 类别的患者具有最佳的身体症状控制、适度到充分的死亡情感准备和接受最少的 LST。中 QODD 类别的患者具有足够的身体症状控制、适度到充分的死亡情感准备和接受最少的 LST。差到不确定 QODD 类别的患者身体症状控制不足，对死亡的情感准备不足且接受了一些 LST。最差 QODD 类别的患者身体症状控制最差，对死亡的情感准备不足且接受了大量 LST。最差 QODD 类别的死者代理人在评估患者整体 QODD、对 ICU 护理和决策过程的满意度方面的得分明显低于其他类别。
确定的不同 QODD 类别为改善临终 ICU 护理质量提供了潜在的可行方向。
