Giving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach

Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents

“…Patients in the poor-to-uncertain QODD class received inadequate symptom management and suffered from frightening and distressing LSTs, which may have led bereaved surrogates to perceive the patient’s dying and death as peaceless, undignified, and traumatizing. Furthermore, these bereaved surrogates reported uncertainty about their loved one’s emotional preparedness for death, including whether the patient cleared up bad feelings, or worried about imposing strains on family, which may have further traumatized their bereavement because these issues are considered important by patients and families for a good death ( 37 , 49 ). Bereaved surrogates who doubted whether their loved one completed those important tasks might feel the opportunity to resolve unfinished business has literally passed ( 50 ), leading to a traumatized loss experience and higher reports of PTSD symptoms.…”

“…Objective indicators extracted from the medical record encompassed, for example, prognostic communication, offer of psychosocial support, and LSTs received while subjective assessments covered family perspectives of care (e.g., concern and caring from ICU staff, skill and competence of ICU nurses/physicians, amount of healthcare provided, and ICU/waiting room atmosphere), and the decision-making process (e.g., quality of information, support, and involvement during decision making). However, neither these care-quality measures nor those from other studies ( 10 , 14 – 17 , 19 – 21 ) reflect the full array of EOL-care factors important to dying patients and their families ( 37 ). The QODD domains (see Measures below) in the current study offer new insight into a wide range of clinically modifiable factors that predict for long-term, comprehensive bereavement outcomes.…”