Hospital variation and temporal trends in palliative and end-of-life care in the ICU

Thomas W. Decato, Ruth A. Engelberg, Lois Downey, Elizabeth L. Nielsen, Patsy D. Treece, Anthony L. Back, Sarah Shannon, Erin K. Kross, J. Randall Curtis

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

OBJECTIVES: Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented. DESIGN/SETTING: Retrospective cohort study of consecutive patients dying in the ICU in 13 Seattle-Tacoma-area hospitals between 2003 and 2008. MEASUREMENTS: We examined variability over time and among hospitals in satisfaction and quality of dying assessed by family, quality of dying assessed by nurses, and chart-based indicators of palliative care. We used regression analyses adjusting for patient, family, and nurse characteristics. MAIN RESULTS: Medical charts were abstracted for 3,065 of 3,246 eligible patients over a 55-month period. There were significant differences between hospitals for all chart-based indicators (p < 0.001), family satisfaction (p < 0.001), family-rated quality of dying (p = 0.03), and nurse-rated quality of dying (p = 0.003). There were few significant changes in these measures over time, although we found a significant increase in pain assessments in the last 24 hours of life (p < 0.001) as well as decreased documentation of family conferences (p < 0.001) and discussion of prognosis (p = 0.020) in the first 72 hours in the ICU. CONCLUSIONS: We found significant interhospital variation in ratings and delivery of palliative care, consistent with prior studies showing variation in intensity of care at the end of life. We did not find evidence of temporal changes in most aspects of palliative care, family satisfaction, or nurse/family ratings of the quality of dying. With the possible exception of pain assessment, there is little evidence that the quality of palliative care has improved over the time period studied.

Original languageEnglish (US)
Pages (from-to)1405-1411
Number of pages7
JournalCritical Care Medicine
Volume41
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

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Terminal Care
Palliative Care
Nurses
Pain Measurement
Quality of Health Care
Documentation
Cohort Studies
Retrospective Studies
Regression Analysis

Keywords

  • critical care
  • death
  • dying
  • end-of-life care
  • intensive care
  • palliative care
  • withdrawing life support

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Decato, T. W., Engelberg, R. A., Downey, L., Nielsen, E. L., Treece, P. D., Back, A. L., ... Curtis, J. R. (2013). Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical Care Medicine, 41(6), 1405-1411. https://doi.org/10.1097/CCM.0b013e318287f289

Hospital variation and temporal trends in palliative and end-of-life care in the ICU. / Decato, Thomas W.; Engelberg, Ruth A.; Downey, Lois; Nielsen, Elizabeth L.; Treece, Patsy D.; Back, Anthony L.; Shannon, Sarah; Kross, Erin K.; Curtis, J. Randall.

In: Critical Care Medicine, Vol. 41, No. 6, 06.2013, p. 1405-1411.

Research output: Contribution to journalArticle

Decato, TW, Engelberg, RA, Downey, L, Nielsen, EL, Treece, PD, Back, AL, Shannon, S, Kross, EK & Curtis, JR 2013, 'Hospital variation and temporal trends in palliative and end-of-life care in the ICU', Critical Care Medicine, vol. 41, no. 6, pp. 1405-1411. https://doi.org/10.1097/CCM.0b013e318287f289
Decato TW, Engelberg RA, Downey L, Nielsen EL, Treece PD, Back AL et al. Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical Care Medicine. 2013 Jun;41(6):1405-1411. https://doi.org/10.1097/CCM.0b013e318287f289
Decato, Thomas W. ; Engelberg, Ruth A. ; Downey, Lois ; Nielsen, Elizabeth L. ; Treece, Patsy D. ; Back, Anthony L. ; Shannon, Sarah ; Kross, Erin K. ; Curtis, J. Randall. / Hospital variation and temporal trends in palliative and end-of-life care in the ICU. In: Critical Care Medicine. 2013 ; Vol. 41, No. 6. pp. 1405-1411.
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