Wen Fur-Hsing, Prigerson Holly G, Chuang Li-Pang, Chou Wen-Chi, Hu Tsung-Hui, Huang Chung-Chi, Tang Siew Tzuh
Department of International Business (F.H.W.), Soochow University, Taiwan, R.O.C.
Department of Medicine (H.G.P.), Weill Cornell Medicine. New York City, New York, USA.
J Pain Symptom Manage. 2025 Mar;69(3):251-260.e3. doi: 10.1016/j.jpainsymman.2024.11.023. Epub 2024 Dec 6.
Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes.
Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss.
This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference.
Physical and mental HRQOL were worse in the 3 more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the 3 poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators.
Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.
与健康相关的生活质量（HRQOL）得到了高度认可，但HRQOL研究很少调查以下方面：重症监护病房（ICU）患者家属；可改变的临终（EOL）ICU护理因素；与持续性悲伤障碍（PGD）、创伤后应激障碍（PTSD）和抑郁症的联合关联；以及长期的丧亲结果。
探索性调查PGD-PTSD-抑郁症状状态（复原力强、亚阈值抑郁为主、PGD为主、PGD-PTSD-抑郁共病）和EOL ICU护理质量与丧亲后6至24个月家庭HRQOL之间的关联。
这项队列研究调查了303名ICU患者家属的PGD症状（PG-13的11项）、PTSD症状（事件影响量表修订版）和抑郁症状（医院焦虑抑郁量表），以及HRQOL（医学结局研究36项简短健康调查）。EOL ICU护理质量通过从医疗记录中提取的基于客观过程的护理质量指标进行衡量，并根据主观的家庭评估的患者死亡质量（QODD）进行分类。通过多变量分层线性模型同时检验关联，以复原力状态和高QODD类别作为参照。
在3种更痛苦的症状状态下，身体和心理HRQOL更差，尤其是心理HRQOL呈现出剂量反应递增效应：亚阈值抑郁为主（β[95%CI]=-2.419[-3.374，-1.464]）、PGD为主（-8.366[-10.116，-6.616]）和PGD-PTSD-抑郁共病（-14.736[-17.772，-11.700]）状态。在3种较差的QODD类别中，心理HRQOL显著更差：中等（-1.085[-2.138，-0.032]）、差至不确定（-4.362[-5.616，-3.108]）和最差（-3.239[-4.433，-2.045]）。HRQOL与客观护理质量指标无关。
丧亲家庭成员的HRQOL与PGD-PTSD-抑郁症状状态和QODD类别显著相关，两者均可通过高质量的EOL ICU护理得到改善
