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Quality of Dying and Death in Two Medical ICUs^*

Perceptions of Family and Clinicians

^* From the Division of Healthcare Policy and Research (Dr. Levy), University of Colorado Health Sciences Center, Aurora, CO; Department of Internal Medicine (Dr. Ely), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine (Dr. Payne), St. Thomas Hospital, Nashville, TN; and Division of Pulmonary and Critical Care (Drs. Engleberg, Patrick, and Curtis), University of Washington, Seattle, WA.

Correspondence to: Cari Levy, MD, University of Colorado Health Sciences Center, Division of Health Care Policy and Research, 13611 E Colfax Ave, Suite 100, Aurora, CO 80011; e-mail: cari.levy{at}uchsc.edu

Objective: We compared perceptions of the quality of dying and death in the ICU across nurses, resident physicians, attending physicians, and family members. The aim was to obtain a surrogate assessment of the quality of the dying process and examine differences in the perceptions of different types of raters.

Design: Cross-sectional survey of family members and ICU clinicians conducted following the death of enrolled patients.

Setting: Two medical ICUs at academic tertiary care medical centers.

Patients: Patients dying in the ICU (n = 68).

Measurements and results: The previously validated Quality of Dying and Death (QODD) instrument was modified for use in the ICU. Within 48 h of the time of death, the nurse, resident, and attending physician caring for the patient were asked to complete the QODD. One month following the death, a designated family member was contacted and the QODD was administered on the telephone. Family members and attending physicians gave the most favorable ratings of death, while nurses and residents provided less favorable ratings. Significant differences between these groups were notable (p < 0.01) on items related to patient autonomy: maintaining dignity, being touched by loved ones, and the overall quality of death.

Conclusions: The perception of dying and death in the ICU varies considerably between nurses, attending physicians, resident physicians, and family members. Further studies are needed to explain these differences and determine the utility of the ICU QODD instrument for assessing and improving the quality of end-of-life care in the ICU.

Key Words: critical care • death • geriatrics • ICU • quality of care • quality of dying

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