Table 2 EOLC on ICU items and interdisciplinary response pattern
From: A beginner’s view of end of life care on German intensive care units
Category | Medical | Surgical | P* = | ||
|---|---|---|---|---|---|
Prognosis and outcome (Q 1–6) | |||||
Q1 | Scores, such as SAPS II or SOFA, to estimate a patient’s individual prognosis? (ICU stay < 24 h?) | 1 | 25/125 | 15/63 | 0.574 |
Q2 | Scores, such as SAPS II or SOFA, to estimate a patient’s individual prognosis? (With ICU stay > 24 h?) | 1 | 46/119 | 18/59 | 0.322 |
Q3 | Do you receive outcome data regarding long-term survival after hospital discharge? | 3 | 74/120 | 34/64 | 0.275 |
Q4 | Do you receive outcome data from patients discharged to other hospitals or rehabilitation centers? | 3 | 43/119 | 28/63 | 0.338 |
Q5 | Do you receive outcome data from patients discharged home? | 3 | 71/121 | 39/63 | 0.752 |
Q6 | Do you use outcome data from your hospital for your decisions? | 3 | 41/111 | 19/59 | 0.614 |
Goals of care (curative versus palliative) (Q 7–17) | |||||
Q7 | Do you use principles of palliative care? | 1 | 59/120 | 25/62 | 0.276 |
Q8 | Do you address goals of care within 72 h of ICU admission? | 1 | 91/112 | 48/63 | 0.441 |
Q9 | Do you discuss goals of care and prognosis with patients and families? | 1 | 107/117 | 59/63 | 0.773 |
Q10 | Do you document the items and results of these conversations with patients? | 1 | 93/114 | 54/63 | 0.536 |
Q11 | Do you document the items and results of these conversations with relatives? | 1 | 92/114 | 52/61 | 0.536 |
Q12 | Do you discuss indications in an interdisciplinary manner? | 1 | 71/118 | 42/63 | 0.424 |
Q13 | Do you discuss whether goals are achievable? | 1 | 80/117 | 47/64 | 0.502 |
Q14 | Do you discuss ineffective therapy? | 1 | 82/115 | 43/63 | 0.733 |
Q15 | Do you establish feasible and realistic treatment goals? | 1 | 89/113 | 54/63 | 0.316 |
Q16 | Do you discuss whether a desirable quality of survival is achievable? | 1 | 73/117 | 36/63 | 0.525 |
Q17 | Do you decide on and document to allow natural death (AND)? | 1 | 66/115 | 37/61 | 0.749 |
Patient autonomy (Q 18–24) | |||||
Q18 | Do you document the assumed consent of the patient? | 1 | 88/117 | 49/63 | 0.855 |
Q19 | Do you document conversations with relatives regarding the assumed consent of the patient? | 1 | 1/123 | 0/65 | 0.814 |
Q20 | Do you document conversations with the patients regarding their priorities regarding their way of life, their perceptions of quality of live, and their wishes for the future? | 1 | 60/116 | 30/62 | 0.753 |
Q21 | Do you have guidelines for dealing with delicate wishes of patients? | 3 | 56/121 | 25/61 | 0.530 |
Q22 | Do you have an ethics committee? | 1 | 43/115 | 33/62 | 0.056 |
Q23 | Do you perform ethics councils? | 2 | 38/115 | 22/61 | 0.739 |
Q24 | Do you perform interdisciplinary ethics case reviews? | 2 | 37/121 | 29/63 | 0.052 |
Standard operating procedures (SOPs), quality management (Q 25–27) | |||||
Q25 | Do you have SOPs for psychosocial problems? | 3 | 51/122 | 25/61 | 1.000 |
Q26 | Do you have SOPs for spiritual problems? | 6 | 48/121 | 33/60 | 0.058 |
Q27 | Do you have a room for taking farewell? | 1 | 60/118 | 37/62 | 0.275 |
Which changes in goals of care do you execute in these instances? (Q 28–35) | |||||
Q28 | Continuation and escalation of therapy with all consecutive life-sustaining activities? | 1 | 53/113 | 37/64 | 0.211 |
Q29 | Change in goals of care, adjustment of therapy to the new goals, usually by limitations of care? | 1 | 80/110 | 42/64 | 0.391 |
Q30 | DNR (Do Not Resuscitate) | 1 | 79/112 | 47/63 | 0.603 |
Q31 | DNE (Do Not Escalate) | 1 | 62/114 | 42/64 | 0.157 |
Q32 | RID (Re-evaluate Indication and De-escalate) | 2 | 59/114 | 29/62 | 0.533 |
Q33 | CTC (Comfort Terminal Care) | 1 | 53/114 | 21/62 | 0.113 |
Q34 | Is the decision to changing goals of care authorized by a physician, communicated during handover of duty, checked daily and documented in the patient chart / patient data management system? | 1 | 79/113 | 48/61 | 0.283 |
Q35 | Do you have a checklist” Items for intensive care medicine for individual changes in treatment goals”? | 3 | 50/114 | 31/58 | 0.260 |
Nursing aspects (Q 36–38) | |||||
Q36 | Do you integrate nurses’ opinions? | 1 | 81/112 | 38/62 | 0.173 |
Q37 | Do you implement palliative care concepts, such as adaption of oral care, noise, light, basal stimulation? | 1 | 57/109 | 26/60 | 0.335 |
Q38 | Is the nursing staff educated in palliative care? | 2 | 54/109 | 30/57 | 0.745 |
Concepts of care in the terminal phase (Q 39–48) | |||||
Q39 | Do you use SOPs for EOL? | 3 | 35/116 | 16/56 | 0.861 |
Q40 | Do you do an appraisal of the initial situation? | 1 | 61/112 | 31/60 | 0.751 |
Q41 | Is there care for others, such as relatives or the primary care physician, once the patient has died? | 1 | 44/116 | 21/59 | 0.869 |
Q42 | Do you use the Liverpool pathway of care? | 6 | 60/92 | 35/49 | 0.572 |
Q43 | Do you administer diaries of patients? | 6 | 69/106 | 39/62 | 0.868 |
Q44 | Do you administer diaries of relatives? | 6 | 81/114 | 44/63 | 0.865 |
Q45 | Do you involve relatives to attend when death occurs? | 1 | 99/109 | 52/65 | 0.062 |
Q46 | Do you offer attendance by psychologists, social workers, spiritual care? | 1 | 77/112 | 46/64 | 0.734 |
Q47 | Do you consider intercultural aspects? | 1 | 67/111 | 31/64 | 0.155 |
Q48 | Are visiting hours handled flexible according to the needs of the Relatives? | 1 | 81/112 | 39/64 | 0.132 |