Assessing and Treating Symptoms of Dying ICU Patients

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): The purpose of this prospective, descriptive study is to examine the symptom experiences of Intensive Care Unit (ICU) patients at high risk of dying and the pharmacologic management of those symptoms. The study's specific aims are to examine the perspectives of ICU patients at high risk of dying as well as family members, ICU nurses, and physicians in order to: (1) determine patient symptom characteristics (i.e., prevalence, intensity, frequency, and distress) across time in ICU; (2) determine level of agreement regarding patient symptom characteristics among patients, family members, nurses, and physicians; (3) examine the association of certain factors [e.g., age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and "do-not-resuscitate" (DNR) status] with symptom characteristics; (4) evaluate pharmacologic symptom management practices for certain symptoms (e.g., pain, anxiety, shortness of breath, restlessness, and confusion). The study sample will be 250 English-, Spanish-, and Chinese-speaking ICU patients at high risk of dying as well as their family members, ICU nurses, and ICU physicians who will be proxy informants. Patients and informants will rate patient symptom characteristics using a 10-item symptom checklist on seven days of the patient's ICU stay. Demographic, medication, and diagnostic data will be obtained through patient chart reviews. Patient illness acuity levels will be calculated per APACHE II, and nurse-patient staffing ratios, hospital site, and patient's DNR status will be recorded. Mixed-effects models will be used to analyze patient symptom characteristics across time in ICU and to make comparisons of symptom characteristics according to the different groups of informants. The mixed effects models will examine associations among potential explanatory variables (age, gender, ethnicity, illness acuity, nurse-patient staffing ratios, hospital site, and DNR status) and patient symptom characteristics. Regression analyses will be used to examine the influence of specific factors on pharmacologic symptom management practices. The study will provide a unique and comprehensive understanding of symptoms experienced by patients at high risk of dying in ICUs. Results will also contribute empirical data needed to generate and test hypotheses concerning appropriate symptom assessment and management interventions.