Assessing End of Life Communication in Intensive Care Patients Using Conceptual Framework and Quality Indicators
End of Life Communication
Keywords:End of Life Communication
Most deaths in Canada occur in hospitals, and almost one in five occurs in intensive care units (ICUs). The goal of this study is to assess the quality of end-of-life (EOL) communication in two important groups in intensive care in Winnipeg: (i) those who live in personal care homes (PCH) and (ii) those with severe cardiovascular and/or respiratory failure placed on an artificial life support called extracorporeal membrane oxygenation (ECMO). Two domains of EOL communication were studied: Goals of Care Discussion (GOCD) and Documentation. We used a validated conceptual framework for the quality of EOL communication and documentation, operationalized by 18 specific quality indicators (QIs). We performed a retrospective, manual review of hospital charts (107 charts from the PCH subgroup and 103 charts from the ECMO subgroup) to extract these QIs. Overall, the quality of EOL communication and documentation was low. Despite the ECMO cohort being the sicker group with worse in-hospital mortality rates, the quality of EOL communication was significantly worse compared to PCH group. Quality of EOL communication was highly influenced by patient physiologic status adjusted for age, sex, year of admission, disease category, socioeconomic quintile and urban status.
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