Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit

Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU.Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis.Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean;pvalue), including discussing bad news (3.3; 4.2;p<0.01), conducting a family conference (3.1; 4.1;p<0.01), discussing treatment options (3.2; 3.9;p<0.01), discussing discontinuing ICU treatments (2.9; 3.5;p<0.01), and expressing empathy (3.9; 4.5;p<0.01). Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly.Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents’ confidence to discuss EOL care with family members of patients in the ICU.

Download Full-text

FACTORS AFFECTING INTENSIVE CARE AND MORTALITY IN SARS-CoV 2019 HOSPITAL PATIENTS

10.36106/ijsr/8045338 ◽

2021 ◽

pp. 7-11

Author(s):

Gulfidan Uzan ◽

Bedriye Kar ◽

Evren Canel Karakas ◽

Macit Koldas ◽

Mehmet Mesut Sonmez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Laboratory ◽

Treatment Options ◽

Shortness Of Breath ◽

Factors Affecting ◽

Laboratory Parameters ◽

Radiological Data ◽

Hospital Patients

Backround: Information on prognosis and treatment in COVID-19 is limited and variable. We wanted to report the demographic, clinical, laboratory, radiological data and treatment and follow-up results of our patients diagnosed with COVID-19 in the study and to determine the factors affecting prognosis and mortality. Materials-methods: The study included 1161 inpatients with PCR positive and/or radiologically diagnosed COVID-19 pneumonia. Of these, 151 patients were taken to the intensive care unit and 37 patients were intubated. The data obtained through the system were evaluated retrospectively and observationally. Results: The mean age of 1161 inpatients was 54.5 years and 616 (53.1%) were male. 104 (8.9%) of 1161 inpatients died. 151 (13%) were taken to the intensive care unit. Of these, 37 (24.5%) were intubated. The analysis revealed age(p<0.001), gender(p<0.001), presence of comorbid disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), fatigue and malaise symptoms (p<0.001) and in the laboratory and signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).When the living and deceased patients were compared; age (p<0.001), gender(p=0.001), presence of additional disease (p<0.001), cough(p<0.001), shortness of breath (p<0.001), malaise and fatigue symptoms (p<0.001), in the laboratory; signicant correlation was found with some laboratory parameters and some treatment options (p<0.001).Conclusion: We believe that these data obtained in our study will be important in predicting prognosis and mortality and in effective patient management. We wanted to emphasize that hydroxychloroquine, favipravir, methylprednisolone and enoxoparin are effective in reducing mortality in the treatment.

Download Full-text

The family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvement

Critical Care Medicine ◽

10.1097/00003246-200102001-00006 ◽

2001 ◽

Vol 29 (Supplement) ◽

pp. N26-N33 ◽

Cited By ~ 239

Author(s):

J. Randall Curtis ◽

Donald L. Patrick ◽

Sarah E. Shannon ◽

Patsy D. Treece ◽

Ruth A. Engelberg ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Family Conference ◽

The Family

Download Full-text

End-of-Life Discussions and Aggressiveness of Care Received Near Death (DRAFT)

10.1093/med/9780190658618.003.0037 ◽

2018 ◽

Author(s):

Yael Schenker ◽

Justin Yu

Keyword(s):

Colorectal Cancer ◽

Intensive Care Unit ◽

Intensive Care ◽

End Of Life ◽

Stage Iv ◽

Intensive Care Unit Care ◽

Cancer Stage ◽

Eol Care ◽

The Relationship ◽

Advanced Cancer Stage

This chapter summarizes Mack and colleagues’ 2012 Associations Between End-of-Life (EOL) Discussion Characteristics and Care Received Near Death, which investigates the relationship between EOL discussion characteristics and the aggressiveness of EOL medical care received by patients with advanced cancer (stage IV lung or colorectal cancer). It reviews the frequency of which EOL discussions occur in this population and explores EOL discussion characteristics including timing, location, and involved providers. It then examines how these characteristics are associated with various markers of aggressive EOL care such as chemotherapy in last 14 days of life (DOL), acute or intensive care unit care in last 30 DOL, and initiation of hospice in last seven DOL.

Download Full-text

Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar

Journal of Global Oncology ◽

10.1200/jgo.2015.000620 ◽

2016 ◽

Vol 2 (2) ◽

pp. 68-75 ◽

Cited By ~ 3

Author(s):

Azza A. Hassan ◽

Hassan Mohsen ◽

Ayman A. Allam ◽

Pascale Haddad

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

End Of Life ◽

Cancer Care ◽

The State ◽

Care Services ◽

Palliative Care Services ◽

Excellent Care ◽

Eol Care

Purpose Quality of end-of-life (EOL) care is a key component of excellence in cancer care, and monitoring indicators for quality of EOL cancer care is crucial to providing excellent care. The aim of the current study is to describe the relative aggressiveness of EOL cancer care in the state of Qatar and to compare it with international figures. Methods We analyzed all deaths from cancer in Qatar between January 1, 2009 and December 31, 2013. A total of 784 eligible patients were studied to assess aggressiveness of cancer care at EOL. Results The average number of intensive care unit admissions per person decreased from 0.44 to 0.22 (P < .001) over the period of study. In addition, patients spent fewer days in the intensive care unit (2.79 to 1.82 days; P = .006) and made fewer visits to the emergency department (1.00 to 0.52 visits; P < .001) in the last 30 days of life. Fewer patients had at least one aggressive treatment measure at EOL during the 5-year period (82.3% to 71.0%; P = .038). The mean composite score for aggressiveness of EOL care decreased from 2.24 to 1.92 (P < .01). Conclusion The aggressiveness of EOL cancer care has significantly decreased over time in Qatar; however, despite this decrease, the rate is still higher than that reported internationally. The integration of community palliative care services in Qatar may further decrease the aggressiveness of cancer care at EOL.

Download Full-text

Ethical Dilemmas of End of Life Care in Intensive Care Unit : A Literature Review

JURNAL PENDIDIKAN KEPERAWATAN INDONESIA ◽

10.17509/jpki.v4i2.13637 ◽

2018 ◽

Vol 4 (2) ◽

Author(s):

Albertus Budi Arianto ◽

Yanny Trisyani ◽

Etika Emiliyawati

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Critical Care ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Ethical Dilemmas ◽

Ethical Principle ◽

Life Care ◽

Eol Care

ABSTRACTThe end-of-life (EOL) care is the progressive terminal illness, leading to death; that in the situation the nurse have significant role in decision making. In decision making, temporarily, the nurse will experiences the ethical dilemmas, including in intensive care unit (ICU) with any factors resulting in problem in medical decision making. The literature review intends to analyze the description of ethical dilemmas occurred in intensive care unit, especially to the EOL care. A method used is critical review full text of 2007-2018 periods in English langguage. The multiple databases used is PubMed, Proquest and Google Scholar with keyword “End of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life critical care”, and “Dilemmas Ethic in ICU.” The articles selected gradually by using of Appraisal tool of PRISMA and obtained 21 articles. The literature study obtaining 4 themes related to description of the ethical dilemmas in ICU including (1) the ethical principle involved in EOL care at ICU, (2) resource of ethical conflict in ICU, (3) impact of ethical conflict in ICU, and (4) response of nurse in dealing with ethical dilemmas. The discussion of literature review related to the perception of nurse on EOL care; that nurse have important role in medical decision making involving ethical principle in the implementation. it is required further research on exploration of nurse experience on implementation of ethical principle in case of EOL care.ABSTRAKPerawatan end of life (EOL) merupakan suatu perawatan pada penyakit terminal yang bersifat progresif, yang akan berujung dengan kematian, pada kondisi ini perawat mempunyai peran dalam pengambilan keputusan perawatan. Terkadang dalam pengambilan keputusan ini perawat akan mengalami kondisi dilema etik, tak terkecuali di ruangan intensive care unit dimana diruangan tersebut banyak faktor yang mengakibatkan kesulitan dalam pengambilan keputusan medis. Literature reviews ini bertujuan untuk menganalisia gambaran dilema etik yang terjadi di area intensive khususnya pada kasus end of life care. Metode yang digunakan adalah critical review full text dengan rentang tahun 2007-2018 dalam Bahasa Inggris. Multiple database yang digunakan adalah PubMed, Proquest dan Google Scholar merupakan database yang digunakan, dengan kata kunci “End Of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life in critical care”, and“Dilema Ethic in ICU”. Artikel diseleksi bertahap menggunakan Appraisal tool PRISMA dan didapatkan 21 artikel. Studi literatur diperoleh 4 tema terkait gambaran dilema etik di ruang ICU diantaranya (1) Prinsip etik yang terlibat dalam end of life care di ICU, (2) Sumber konflik etik di ICU, (3) Dampak konflik etik di ICU, dan (4) Respon perawat dalam menghadapi dilema etik. Pembahasan telaah literatur ini terkait persepsi perawat mengenai perawatan end of life, dimana perawat mempunyai peran penting dalam pengambilan keputusan medis yang melibatkan prinsip etik dalam pelaksanaannya. Diperlukan penelitian lebih lanjut mengenai eksplorasi pengalaman perawat terhadap implementasi prinsip etik pada kasus perawatan menjelang ajal.

Download Full-text

ASSOCIATIONS BETWEEN FAMILY SATISFACTION WITH END-OF-LIFE (EOL) CARE AND IDENTIFIED CHART-DERIVED PROCESS-BASED INDICATORS OF HIGH-QUALITY EOL CARE IN THE INTENSIVE CARE UNIT

CHEST Journal ◽

10.1016/j.chest.2020.05.383 ◽

2020 ◽

Vol 157 (6) ◽

pp. A316

Author(s):

S.T.(. Tang ◽

M.-L. Lo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

End Of Life ◽

Family Satisfaction ◽

High Quality ◽

Eol Care

Download Full-text

An Intensive Care Unit Team Reflects on End-of-Life Experiences With Patients and Families in Chile

American Journal of Critical Care ◽

10.4037/ajcc2022585 ◽

2022 ◽

Vol 31 (1) ◽

pp. 24-32

Author(s):

Alejandra Palma ◽

Verónica Aliaga-Castillo ◽

Luz Bascuñan ◽

Verónica Rojas ◽

Fernando Ihl ◽

...

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Clinical Practice ◽

Focus Groups ◽

End Of Life ◽

Emotional Impact ◽

Urban Hospital ◽

Communication Difficulties ◽

Eol Care

Background Deaths in the intensive care unit (ICU) represent an experience of suffering for patients, their families, and professionals. End-of-life (EOL) care has been added to the responsibilities of the ICU team, but the evidence supporting EOL care is scarce, and there are many barriers to implementing the clinical recommendations that do exist. Objectives To explore the experiences and perspectives of the various members of an ICU care team in Chile regarding the EOL care of their patients. Methods A qualitative study was performed in the ICU of a high-complexity academic urban hospital. The study used purposive sampling with focus groups as a data collection method. A narrative analysis based on grounded theory was done. Results Four discipline-specific focus groups were conducted; participants included 8 nurses, 6 nursing assistants, 8 junior physicians, and 6 senior physicians. The main themes that emerged in the analysis were emotional impact and barriers to carrying out EOL care. The main barriers identified were cultural difficulties related to decision-making, lack of interprofessional clinical practice, and lack of effective communication. Communication difficulties within the team were described along with lack of self-efficacy for family-centered communication. Conclusion These qualitative findings expose gaps in care that must be filled to achieve high-quality EOL care in the ICU. Significant emotional impact, barriers related to EOL decision-making, limited interprofessional clinical practice, and communication difficulties were the main findings cross-referenced.

Download Full-text