Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Abstract

Background: As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient's and/or the relatives' experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. Methods: Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. Results: Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

“…Adaptations included omitting the phrase "nurse" or replacing it with an inclusive term such as "healthcare staff" so as to be applicable to nonnurse participants. Unlike prior surveys on the quality of the dying process (Levy CR et al , 2005) or professionals' experience providing end-of-life care (Boissier et al , 2020), the survey by Ranse et al (2015) was designed to assist with strategies for practice development to prepare and support RNs with EOLC in the intensive care setting. The survey consists of 38 items measured across eight concepts related to provisions of end-of-life care: knowledge (four items), preparedness (three items), patient and family preferences (six items), organisational culture (three items), resources (five items), palliative values (five items), emotional support (six items), and care planning (six items) (Ranse K, Yates P, 2015).…”

Assessment of an Instrument to Measure Interdisciplinary Staff Perceptions of Quality of Dying and Death in a Pediatric Cardiac Intensive Care Unit

“…In adult ICUs, data supports early palliative care integration and less invasive interventions result in better end-of-life experience for staff. 41 , 42 Palliative care involvement in CICUs results in less intense therapies at end-of-life. 3 , 15 , 20 Both these factors were associated with positive perceptions of quality of life in the 7 days prior to death in our study, and QODD was perceived highly when staff felt mode of death was aligned with the family’s wishes.…”

“… 49 Finally, nursing and allied health staff may experience frustration about their limited role and participation in end-of-life decision-making. 23 , 41 , 44 Interdisciplinary team support and institutional practices including joint approaches to symptom control, routine team meetings, ethical competency training, and robust discussions sharing perspectives may overcome these challenges. 41 , 43 , 50 , 51 , 52 …”

“… 23 , 41 , 44 Interdisciplinary team support and institutional practices including joint approaches to symptom control, routine team meetings, ethical competency training, and robust discussions sharing perspectives may overcome these challenges. 41 , 43 , 50 , 51 , 52 …”

Improving the intensive care experience from the perspectives of different stakeholders

“…This complexity does not only relate to caring for certain patient groups but also to participation in decision-making. The involvement in decisions relating to treatment withdrawal or organ donation has been challenging for many ICU professionals [ 37 – 39 ]. The low research priority given to delirium care has caused frustration to ICU nurses, due to the resulting lack of confidence in assessing delirium.…”