Characteristics, Mortality Rates, and Treatments Received in Last Few Days of Life for Patients Dying in Intensive Care Units: A Multicenter Study

Abstract

Background: Information is presently lacking about the end-of-life care in intensive care unit (ICU). We explored the characteristics, mortality rates, and treatments received in the last few days of life for patients who died in ICU. Methods: This was a retrospective multicenter cohort study. We included patients who died from different medical illnesses between January 2014 and January 2017 in 8 medical ICUs across 3 major health-care systems in Jordan. Of 11 029 patients who were admitted for the study in ICUs, data from 3885 health records were retrieved and analyzed. Pediatric patients aged younger than 18 years and patients admitted to an ICU for less than 4 hours were excluded. Results: The mean ICU mortality rate was 34.6% (29%-38%), with a slight decline from 2014 through 2016. Most of the patients who died were male (56.6%), transferred from the emergency department (46.8%), and had multiple comorbidities (74%). Cardiopulmonary resuscitation, invasive mechanical ventilation, pharmacological hemodynamic support, and artificial hydration were pursued until death for most patients (91.5%, 80.1%, 78.8%, and 94.1%, respectively). Conclusions: Aggressive treatment modalities were usually pursued for critically ill patients at the end of their lives. There is a need to explore further the current end-of-life care needs and practices in ICUs in Jordan and to tailor end-of-life care and management suitably to meet the needs of Islamic and Arabic cultures.

Characteristics of Adult Sepsis Patients in the Intensive Care Units in a Tertiary Hospital in Jordan: An Observational Study

“…We found that the all-cause ICU mortality rate was 18.0%, which is lower than the mortality rate of 34.6% reported by a retrospective multicentre study conducted in Jordan from 2014 to 2017 [14]. e study noted that university hospitals such as the one in which we conducted this study had lower mortality rates.…”

“…Some limitations and strengths of this study need to be addressed. First, the ICUs in which we conducted this study are not representative of all ICUs in Jordan, since academic hospitals often provide clinical capabilities unavailable in nonacademic hospitals [14,31]. Another limitation is the sample size; we were not able to achieve the desired sample size due to changes in the ICUs' structure (done in order to accommodate COVID-19 patients) which eventually led to termination of the study.…”

Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study

“…Providing end‐of‐life care is challenging in a Jordanian intensive care context, which is attributed to the fraught of cultural issues including over‐optimistic hope, in addition to other religious and medico‐legal concerns (Almansour, 2015; Almansour, Ahmad, et al, 2020; Almansour et al, 2019). Khader (2017) summarises the main cultural challenges hindering the provision of palliative care services in Jordan.…”

“…Providing end-of-life care is challenging in a Jordanian intensive care context, which is attributed to the fraught of cultural issues including over-optimistic hope, in addition to other religious and medico-legal concerns (Almansour, 2015;Almansour, Ahmad, et al, 2020;Almansour et al, 2019). Khader (2017) of family and physicians to refer patients to palliative care because it might be considered a failure of their cure and (4) religious misconceptions leading the patient to suffer intolerable pain as a form of salvation that also often prevent them from seeking medical attention.…”

“…Jordan, where the study reported in this paper took place, is an Islamic state where most of the population (92%) are Sunni Muslims and 6% are Christians; of the rest, small Shia, Sufi and Druze populations can also be found in Jordan (The Embassy of the Hashemite Kingdom of Jordan‐Washington). The highest percentage of deaths in Jordan occurs in hospital settings, particularly in ICUs (Almansour, 2015; Almansour et al, 2020). Jordan has documented major advances in the area of palliative and end‐of‐life care for cancer patients (Shamieh et al, 2020); however, existing palliative care services in Jordan are mainly based on end‐of‐life care of cancer patients in oncology care settings (Bingley & Clark, 2009; Shamieh & Hui, 2015).…”