Assessing quality end-of-life communication and documentation in intensive care patients using a conceptual framework and quality indicators
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Date
2019
Authors
Pham, Tammy
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Abstract
Most deaths in Canada occur in hospitals, and almost one in five occurs in intensive care
units (ICUs). The goal of this study is to assess the quality of end-of-life (EOL) communication
in two important groups in intensive care in Winnipeg: (i) those who live in personal care homes
(PCH) and (ii) those with severe cardiovascular and/or respiratory failure placed on an artificial
life support called extracorporeal membrane oxygenation (ECMO). Two domains of EOL
communication were studied: Goals of Care Discussion (GOCD) and Documentation. We used a
validated conceptual framework for the quality of EOL communication and documentation,
operationalized by 18 specific quality indicators (QIs). We performed a retrospective, manual
review of hospital charts (107 charts from the PCH subgroup and 103 charts from the ECMO
subgroup) to extract these QIs. Overall, the quality of EOL communication and documentation
was low. Despite the ECMO cohort being the sicker group with worse in-hospital mortality rates,
the quality of EOL communication was significantly worse compared to PCH group. Quality of
EOL communication was highly influenced by patient physiologic status adjusted for age, sex,
year of admission, disease category, socioeconomic quintile and urban status.
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Keywords
End-of-life