Quality of dying in the ICU - Ratings by family members
Quality of dying in the ICU - Ratings by family members
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DOI：
10.1016/s0012-3692(15)37958-7
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发表时间：
2005-07-01
期刊：
影响因子：
9.6
通讯作者：
Curtis, JR
中科院分区：
文献类型：
--
作者：
Mularski, RA;Heine, CE;Curtis, JR
研究目标：探讨死亡经历的质量以及对在 ICU 死亡的人进行更高质量评级的关联。设计：利用病历审查和使用临终质量 (QODD) 工具对家庭成员进行调查进行回顾性研究。地点：一所大学和退伍军人事务医疗中心附属的四个重症监护室。参与者： 38 名 ICU 死者的 94 名家庭成员。测量和结果：我们探讨了 ICU 经历的组成部分与临终经历质量的总体评级之间的关联。总体而言，家庭成员报告症状控制不佳：47% 的患者大部分或全部时间疼痛得到控制，3% 的患者大部分或全部时间呼吸舒适。家属对死亡质量表达了中等和可变的看法，导致 ICU QODD 总体评分为 60 +/- 14（范围为 0 到 100）[平均值 +/- SD]。较高的 ICU QODD 评分与疼痛控制（r = 0.42，p = 0.009）、事件控制（r = 0.62，p < 0.001）、临终体验的“死亡准备”方面——临终时感到平静（r = 0.69，p < 0.001）以及“全人关怀——保持个人尊严和自尊（r = 0.50，p < 0.001）。结论：在调整症状和个人护理评分后，死亡过程中的某些整体和死亡准备方面，而不是临终护理的积极性，仍然与质量评级最相关。虽然未来的研究应该探索 ICU 死亡质量的重要预测因素，但本研究表明 ICU 临终护理不仅包括控制疼痛，还包括支持尊严、尊重和和平，以及支持尊严、尊重和和平。最大限度地控制患者。
Study objectives: To explore the quality of the dying experience and associations to higher quality ratings for people who died in an ICU.Design: Retrospective study using medical record review and surveys of family members with the Quality of Dying and Death (QODD) instrument. Setting: Four ICUs affiliated with a university and a Veterans Affairs Medical Center. Participants: Ninety-four family members of 38 ICU decedents.Measurements and results: We explored associations between components of the ICU experience and the overall rating of the quality of the dying experience. Overall, family members reported that symptoms were poorly controlled: pain under control most or all of the time in 47%, and breathing comfortably most or all of the time in 3% of patients. Families expressed a moderate and variable view of the quality of dying resulting in an overall ICU QODD score of 60 +/- 14 (on a scale of 0 to 100) [mean +/- SD]. Higher ICU QODD scores were associated with control of pain (r = 0.42, p = 0.009), control of events (r = 0.62, p < 0.001), a "preparation for death" aspect of the dying experience-feeling at peace with dying (r = 0.69, p < 0.001), and a "whole-person concern- keeping one's dignity and self-respect (r = 0.50, p < 0.001).Conclusions: After adjusting for symptom and personal care scores, certain whole-person and preparation-for-death aspects of the dying process, and not aggressiveness of end-of-life care, remained the most associated to quality ratings. While future research should explore the important predictors of quality of dying in the ICU, this study suggests that care at the end of life in the ICU include not only managing pain, but also supporting dignity, respect, and peace, and maximizing patient control.