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Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.

Abstract：

OBJECTIVE:To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity. DESIGN:Descriptive observational study. SETTING:Five intensive care units. PATIENTS:One hundred sixteen family surrogate decisionmakers of long-stay intensive care unit patients who participated in an intensive communication system that aimed to provide weekly meetings with family decisionmakers. The structure of each meeting was to address medical update, patient preferences, treatment plan, and milestones for evaluating the treatment plan. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We audiotaped initial family meetings for 116 family decisionmakers for a total of 180 meetings. On average, meetings were 24 mins long with a majority of time being devoted to nonemotional speech and little (12%) spent discussing patient preferences. Quality of life was discussed in 45% and treatment limitation in 23% of all meetings. Quality-of-life discussions were more likely to occur when patients were admitted to a medical intensive care unit (odds ratio [OR] 5.9; p = .005), have a family decisionmaker who is a spouse (OR 9.4; p = .0001), were older (OR 1.04; p = 01), have a shorter length of stay (OR 0.93; p = .001), and have a family decisionmaker who was a spouse (OR 5.1; p = .002). For those with a treatment limitation discussion, 67% had a do-not-resuscitate order, 40% were admitted to a medical intensive care unit, 56% had a family decisionmaker who had been their caregiver, and 48% of their family decisionmakers were their children. CONCLUSIONS:To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Douglas SL,Daly BJ,Lipson AR

doi

10.1097/CCM.0b013e318232d8c4

subject

Has Abstract

pub_date

2012-02-01 00:00:00

pages

461-7

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

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Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.