Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments
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Published:2020-08-25
Issue:1
Volume:24
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Boissier FlorenceORCID, Seegers Valérie, Seguin Amélie, Legriel Stéphane, Cariou Alain, Jaber Samir, Lefrant Jean-Yves, Rimmelé Thomas, Renault Anne, Vinatier Isabelle, Mathonnet Armelle, Reuter Danielle, Guisset Olivier, Cracco Christophe, Durand-Gasselin Jacques, Éon Béatrice, Thirion Marina, Rigaud Jean-Philippe, Philippon-Jouve Bénédicte, Argaud Laurent, Chouquer Renaud, Papazian Laurent, Dedrie Céline, Georges Hugues, Lebas Eddy, Rolin Nathalie, Bollaert Pierre-Edouard, Lecuyer Lucien, Viquesnel Gérald, Leone Marc, Chalumeau-Lemoine Ludivine, Garrouste-Orgeas Maité, Azoulay Elie, Kentish-Barnes Nancy
Abstract
Abstract
Background
As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient’s and/or the relatives’ experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study.
Methods
Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort.
Results
Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002).
Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside.
Conclusion
We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
Funder
Ministère des Affaires Sociales, de la Santé et des Droits des Femmes
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference30 articles.
1. Mularski R, Curtis JR, Osborne M, Engelberg RA, Ganzini L. Agreement among family members in their assessment of the Quality of Dying and Death. J Pain Symptom Manag. 2004;28(4):306–15. 2. Mularski RA, Heine CE, Osborne ML, Ganzini L, Curtis JR. Quality of dying in the ICU: ratings by family members. Chest. 2005;128(1):280–7. 3. Osborn TR, Curtis JR, Nielsen EL, Back AL, Shannon SE, Engelberg RA. Identifying elements of ICU care that families report as important but unsatisfactory: decision-making, control, and ICU atmosphere. Chest. 2012;142(5):1185–92. 4. Gerritsen RT, Hofhuis JGM, Koopmans M, van der Woude M, Bormans L, Hovingh A, Spronk PE. Perception by family members and ICU staff of the quality of dying and death in the ICU: a prospective multicenter study in the Netherlands. Chest. 2013;143(2):357–63. 5. Kentish-Barnes N, Seegers V, Legriel S, Cariou A, Jaber S, Lefrant JY, Floccard B, Renault A, Vinatier I, Mathonnet A, et al. CAESAR: a new tool to assess relatives’ experience of dying and death in the ICU. Intensive Care Med. 2016;42(6):995–1002.
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