Palliative care indicators associated with nurse-rated quality of dying in the intensive care unit

Abstract

Background: Palliative care is important in the intensive care unit (ICU) but specific indicators of quality palliative care are not yet well understood. Objective: To identify palliative care quality indicators that are associated with nurse-ratings of the quality of dying for patients who die in the ICU. Design: Cohort study using data from a multi-center trial of a hospital-based palliative care intervention. Setting/Subjects: The study sample included patients who died in 14 Seattle-Tacoma ICUs from 2003-2008. Measurements: The primary outcome was the single-item nurse rating of quality of dying (QOD-1). Palliative care quality indicators were: involvement of a social worker, involvement of a spiritual care provider, do not resuscitate (DNR) orders in place at time of death, life-sustaining treatment withheld/withdrawn, pain assessment in the last 24 hours of life, CPR avoided in last hour of life, family conference in first 72 hours of ICU admission, and prognosis discussion in first 72 hours of ICU admission. Results: Higher nurse QOD-1 was associated with having DNR orders in place at time of death, withdrawing/withholding life-sustaining treatment, avoiding CPR in the last hour of life, and occurrence of a family conference in the first 72 hours of ICU admission (all p < 0.001). Conclusions: As rated by nurses, patients who had a family conference and avoided aggressive end of life procedures had a better dying experience. Improving end of life treatment planning may be important for increased quality of care for patients who die in the ICU.