The Hard Task of Improving the Quality of Care at the End of Life

Morrison, R. Sean; Siu, Albert L.; Leipzig, Rosanne M.; Cassel, Christine K.; Meier, Diane E.

doi:10.1001/archinte.160.6.743

Cited by 69 publications

(45 citation statements)

References 77 publications

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“…Fourth, our response rate for family members was 55%, which could introduce response bias. However, this response rate was the same in the pre-and postintervention periods and is similar to other survey studies enrolling family members after the death of a loved one (49)(50)(51). Finally, this study occurred at one hospital and the effect of the intervention on the quality of care may be institution specific.…”

Section: Discussionsupporting

confidence: 80%

Integrating Palliative and Critical Care

Curtis

Treece

Nielsen

et al. 2008

Am J Respir Crit Care Med

186

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Rationale: Palliative care in the intensive care unit (ICU) is an important focus for quality improvement. Objectives: To evaluate the effectiveness of a multi-faceted quality improvement intervention to improve palliative care in the ICU. Methods: We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. The intervention consisted of clinician education, local champions, academic detailing, feedback to clinicians, and system support. Consecutive patients who died in the ICU were identified pre-(n 5 253) and postintervention (n 5 337). Families completed Family Satisfaction in the Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) surveys. Nurses completed the QODD. The QODD and FS-ICU were scored from 0 to 100. We used Mann-Whitney tests to assess family results and hierarchical linear modeling for nurse results. Measurements and Main Results: There were 590 patients who died in the ICU or within 24 hours of transfer; 496 had an identified family member. The response rate for family members was 55% (275 of 496) and for nurses, 89% (523/590). The primary outcome, the family QODD, showed a trend toward improvement (pre, 62.3; post, 67.1), but was not statistically significant (P 5 0.09). Family satisfaction increased but not significantly. The nurse QODD showed significant improvement (pre, 63.1; post, 67.1; P , 0.01) and there was a significant reduction in ICU days before death (pre, 7.2; post, 5.8; P , 0.01). Conclusions: We found no significant improvement in familyassessed quality of dying or in family satisfaction with care, we found but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. Improving family ratings may require interventions that have more direct contact with family members.

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Section: Discussionsupporting

confidence: 80%

Integrating Palliative and Critical Care

Curtis

Treece

Nielsen

et al. 2008

Am J Respir Crit Care Med

186

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“…The majority of terminally ill patients, however, receive one or more life-sustaining treatments (LST) before they die [7][8][9][10]. Families play an important role in EOL decisions [11][12][13], and futile, aggressive care can cause them great psychological strain [14,15].…”

Section: Introductionmentioning

confidence: 99%

The life-sustaining treatments among cancer patients at end of life and the caregiver’s experience and perspectives

Yun

Lee

Chang

et al. 2009

Support Care Cancer

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“…Practitioners in general palliative care do not always feel optimally equipped to perform all the extensive and complex tasks associated with palliative care [4,[20][21][22]31]. One reason for this is the low number of palliative care patients that a professional usually treats or cares for per year, especially in primary care [10,11].…”

Section: Introductionmentioning

confidence: 99%