New research reveals that the families of patients who died in the intensive care unit (ICU) had higher satisfaction of care ratings than families of patients who survived their time in the ICU. The study, which appears in the November issue of CHEST, the journal of the American College of Chest Physicians (ACCP), shows that while the families of ICU survivors and nonsurvivors were equally satisfied with the treatment that their loved one received, the families of nonsurvivors were two to three times more likely to give higher ratings regarding family-centered aspects of care. In contrast, the families of ICU survivors were shown to be less pleased with their overall ICU experience.
"For several years, our research team has focused on improving the quality of care delivered to critically ill patients and their families. When we began this study, we had assumed that families of dying patients would be less satisfied with their ICU experience because their loved ones didn't make it home alive. So, we were initially surprised to find that the opposite was true," said study author Richard J. Wall, MD, MPH, an intensivist at Valley Medical Center in Renton, WA. "However, when we looked more closely at the specific reasons for this, the findings made sense."
To identify specific aspects of care that lead to family member satisfaction, Dr. Wall and his colleagues from the University of Washington, Seattle, mailed a survey packet to the homes of patient families 4 to 8 weeks after ICU discharge. Included were a cover letter explaining the study, the 24-item Family Satisfaction in the Intensive Care Unit questionnaire, and demographic questions about the patient and respondent. A total of 539 family members responded, of which 51% had a loved one die in the ICU.
"Up to 20% of all deaths in the United States occur in or shortly after an ICU stay. Many of these patients are surrounded by family members who must act as surrogate decision-makers, and who experience stress, fear, anxiety, and depression," Dr. Wall explained. "It's for these reasons that it was important for us to determine and understand the aspects of care that can and need to be improved."
Results showed that families of patients who died in the ICU were much more satisfied with their ICU experience than the families of ICU survivors. The largest differences were shown in the areas of inclusion in decision-making, clinician communication, emotional support, respect and compassion shown to family, willingness of staff to answer questions, and consideration of family needs. Each of these items were classified as an aspect of family-centered care, and none of the items revealed higher satisfaction among family members of survivors.
The study says that, while these findings do not indicate that families of dying patients received "better" care, the findings suggest that ICU clinicians may devote extra effort toward addressing family-centered needs when a patient's death is imminent.
"The desire for information and emotional support is a common theme among all ICU families, regardless of whether a patient lives or dies," Dr. Wall said. "So, clinicians should try to recognize that they may be less likely to provide communication and emotional support to the families of ICU survivors, and they should do what they can to change that." He concluded that clinician-family communication is possibly the most important factor driving family satisfaction in the ICU.
Researchers point out that in order to deliver high quality critical care, physicians must meet the needs of not only the patients but of their families, as well. They also note that patients need to make their medical care wishes known to their family members, and family members must be sure to relay these wishes to physicians, should a critical care situation arise.
Materials provided by American College of Chest Physicians. Note: Content may be edited for style and length.
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