Department of International Business, Soochow University, Taipei, Taiwan, ROC.
Department of Medicine, Weill Cornell Medicine, New York City, NY.
Crit Care Med. 2024 Jun 1;52(6):900-909. doi: 10.1097/CCM.0000000000006199. Epub 2024 Feb 1.
To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst).
Prospective, longitudinal, observational study.
Medical ICUs at two academically affiliated medical centers in Taiwan.
PATIENTS/PARTICIPANTS: Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease.
None.
Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class.
The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.
探讨四个先前确定的临终和死亡质量（QODD）潜在类别（高、中、差-不确定和最差）与家属丧亲结果之间的关系。
前瞻性、纵向、观察性研究。
台湾两家学术附属医疗中心的重症监护病房（ICU）。
患者/参与者：来自高危死亡疾病（急性生理学和慢性健康评估 II 评分>20）的 ICU 患者的 309 名家属代理人，负责决策。
无。
参与者在 1、3、6、13、18 和 24 个月时，使用医院焦虑和抑郁量表的抑郁和焦虑子量表、修订后的事件影响量表、延长悲伤障碍（PGD）量表的 11 项以及医疗结果研究 36 项-项简短健康调查评估了 11 项。我们同时使用多变量分层线性建模，在 24 个月的丧亲期间，检查四个 QODD 潜在类别与心理健康相关的生活质量（HRQOL）和焦虑、抑郁、创伤后应激障碍（PTSD）以及 PGD 症状之间的关联。1 个月后评估的家属代理人的四个不同 QODD 潜在类别与丧亲结果显著相关，除了身体 HRQOL 和 PGD 症状。中度（1.958 [1.144-2.772]，-2.245 [-3.961 至-0.529]）、差-不确定（2.224 [1.438-3.010]，-7.026 [-8.683 至-5.369]）和最差（2.081 [1.215-2.964]，-4.268 [-6.096 至-2.440]）QODD 类别的丧亲代理报告的抑郁症状明显更多，心理健康 HRQOL 较差（β[95%CI]）。与高 QODD 类别相比，中度（2.095 [1.392-2.798]）和差-不确定（0.801 [0.123-1.480]）QODD 类别的丧亲代理报告的焦虑症状更多，而差-不确定 QODD 类别的 PTSD 症状更多（2.889 [1.005-4.774]）比高 QODD 类别的。
四个不同的 QODD 潜在类别与 ICU 家属代理人的丧亲结果显著相关，这表明 ICU 提高临终关怀质量的目标。
