Quality of end-of-life communication in 2 high-risk ICU cohorts: a retrospective cohort study.

Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 101620603 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 2291-0026 (Electronic) Linking ISSN: 22910026 NLM ISO Abbreviation: CMAJ Open Subsets: MEDLINE

Original Publication: Ottawa : Canadian Medical Association, [2013]-[2023]

Communication Barriers* ; Critical Illness*/mortality ; Critical Illness*/psychology ; Death* ; Quality of Life* ; Terminal Care*/methods ; Terminal Care*/psychology; Professional-Patient Relations/*ethics ; Truth Disclosure/*ethics; Advance Care Planning/ethics ; Aged ; Canada/epidemiology ; Extracorporeal Membrane Oxygenation/methods ; Extracorporeal Membrane Oxygenation/mortality ; Extracorporeal Membrane Oxygenation/psychology ; Female ; Humans ; Intensive Care Units/ethics ; Intensive Care Units/standards ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Nursing Homes/ethics ; Nursing Homes/statistics & numerical data ; Prognosis ; Quality of Health Care/organization & administration ; Quality of Health Care/standards ; Risk Assessment ; Severity of Illness Index

Background: Factors influencing the quality of end-of-life communication are relevant to improving end-of-life care. We assessed the quality of end-of-life communication and influencing factors in 2 intensive care unit (ICU) cohorts at high risk of death: patients living in nursing homes and those on extracorporeal membrane oxygenation (ECMO).
Methods: This retrospective cohort study included admissions to 4 ICUs in Winnipeg, Manitoba, from 2000 to 2017. We identified cohorts and influencing factors from the Winnipeg ICU database and by manual chart review. We assessed quality of end-of-life communication using 18 validated, binary quality indicators to calculate a weighted, scaled, composite score (range 0-100). We used median regression to identify factors associated with the composite score.
Results: The ECMO cohort ( n = 109) was younger than the nursing home cohort ( n = 230), with longer hospital stays and higher disease severity. Mean composite scores of end-of-life communication were extremely low in both cohorts (mean 48.5 [standard error of the mean (SEM) 1.7] for the nursing home cohort, 49.1 [SEM 2.5] for the ECMO cohort). Patient characteristics associated with higher median composite scores were older age (5.0 per decade, 95% confidence interval [CI] 2.1-7.8) and lower (worse) Glasgow Coma Scale (GCS) scores (1.8 per GCS point, 95% CI 0.5-3.2). The median composite score rose significantly over time (1.7 per year, 95% CI 0.5-2.8).
Interpretation: The quality of end-of-life communication in ICUs is poor, and factors associated with better prognosis are also associated with worse communication. Direct and early communication should occur with all patients in the ICU and their surrogates, not just those who are believed most likely to die.
Competing Interests: Competing interests: None declared.
(© 2021 CMA Joule Inc. or its licensors.)

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Date Created: 20210522 Date Completed: 20210806 Latest Revision: 20210806

20240513

PMC8177905

10.9778/cmajo.20200146

34021015