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RES202
Evaluation Of A Structured Program For End-Of-Life Care In A Neurologic Critical Care Unit: Surrogate Perspective
By: Susan Yeager; The Ohio State University Medical Center; Columbus, OH
For further information, please contact: susan.yeager@osumc.edu
Purpose: The purpose of this study was to determine whether a structured end of life (EOL) program would improve surrogate experiences with death in the neurologic critical care unit (NCC).
Background/Significance: More than 4 million patients are admitted to the intensive care unit in the United States annually. (2) Of those admitted approximately 500,000 (2) or 10-20% (3) die. In these situations, practitioners are faced with the challenge of not only actively caring for patients, but also supporting families as they transition through the grieving process. Wanting to support patients and families in life and death, and desiring to expand the unique skill sets to support EOL care, a multidisciplinary group convened to create an intervention to support NCC families during patient death.
Methods: A before and after survey design was utilized to obtain results from a total of 73 surrogates. All patients that died in the NCC at Riverside Methodist Hospitals from March 2005-April 2007 were evaluated for inclusion in the study. Exclusion criteria included: patient < 18 years, non English speaking surrogate, patients transferred outside of NCC prior to death, refusal of surrogate to participate. If inclusion criteria were met, phone calls to the deceased next of kin occurred no sooner than three weeks following the death of their loved one. Verbal consent was obtained from thirty-eight surrogates followed by the completion of a 52-item Afterdeath Bereaved Family Member Interview. Utilizing baseline results from both practitioner and surrogate surveys, a multidisciplinary team created the structured EOL program. The intervention consisted of a mandatory 4-hour educational session to sensitive NCC clinicians to EOL issues, a structured algorithm outlining multidisciplinary contact, and a quilted envelope containing symptom education, grief information, verses, and patient momentos (i.e. handprints). Six months after the intervention was completed thirty-five surrogates were called to compare their phone responses to the baseline surrogate’s utilizing the Teno tool.
Results: Statistically significant responses were noted in surrogate areas of providing emotional support (p=.009), overall care rating (p=.04), and explanation of care (p=.05). Variability in the way care was delivered was decreased in all domains and specifically in relation to communication with pt/family, symptom control, and providing emotional support. Trends toward statistical significance were noted in the domains of attending to spiritual needs (p=.0903) and informing and promoting decision-making (p=.1837). Surrogates in phase 2 were noted to be more likely to receive information on the medications used to manage the patient’s symptoms (p=.007).
Conclusions: In conclusion, a structured intervention can decrease perceived surrogate variability in EOL care while improving surrogates perception of emotional support, overall care rating, and explanation of care.
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