X-Message-Number: 26832
Date: Wed, 17 Aug 2005 20:27:05 +0200
From: Eugen Leitl <>
Subject: [: [ccm-l] Quality of Dying in the ICU]

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----- Forwarded message from Eric Hodgson <> -----

From: Eric Hodgson <>
Date: Sun, 14 Aug 2005 21:22:48 +0200
To: 
Subject: [ccm-l] Quality of Dying in the ICU
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Quality of Dying in the ICU 
Ratings by Family Members 

Chest. 2005;128:280-287

Richard A. Mularski, MD; Carlton E. Heine, MD, PhD; Molly L. Osborne, 
MD, PhD; Linda Ganzini, MD, MPH and J. Randall Curtis, MD, MPH 


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. 


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Eugen* Leitl <a href="http://leitl.org">leitl</a>
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ICBM: 48.07100, 11.36820            http://www.leitl.org
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