A content analysis of forms, guidelines, and other materials documenting end-of-life
care in intensive care units.
Clarke EB - J Crit Care - 01-JUN-2004; 19(2): 108-17
From NIH/NLM MEDLINE
NLM Citation ID:
Full Source Title:
Journal of Critical Care
Department of Critical Care Medicine, Brown University, Rhode Island Hospital, Providence,
Clarke EB; Luce JM; Curtis JR; Danis M; Levy M; Nelson J; Solomon MZ
Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup
OBJECTIVE: The purpose of this study was to determine the extent to which data entry
forms, guidelines, and other materials used for documentation in intensive care
units (ICUs) attend to 6 key end-of-life care (EOLC) domains: 1) patient and family-centered
decision making, 2) communication, 3) continuity of care, 4) emotional and practical
support, 5) symptom management and comfort care, and 6) spiritual support. A second
purpose was to determine how these materials might be modified to include more EOLC
content and used to trigger clinical behaviors that might improve the quality of
EOLC. PARTICIPANTS: Fifteen adult ICUs-8 medical, 2 surgical, and 4 mixed ICUs from
the United States, and 1 mixed ICU in Canada, all affiliated with the Critical Care
End-of-Life Peer Workgroup METHODS: Physician-nurse teams in each ICU received detailed
checklists to facilitate and standardize collection of requested documentation materials.
Content analysis was performed on the collected documents, aimed at characterizing
the types of materials in use and the extent to which EOLC content was incorporated.
MEASUREMENTS AND MAIN RESULTS: The domain of symptom management and comfort care
was integrated most consistently on forms and other materials across the 15 ICUs,
particularly pain assessment and management. The 5 other EOLC domains of patient
and family centered decision-making, communication, emotional and practical support,
continuity of care, and spiritual support were not well-represented on documentation.
None of the 15 ICUs supplied a comprehensive EOLC policy or EOLC critical pathway
that outlined an overall, interdisciplinary, sequenced approach for the care of
dying patients and their families. Nursing materials included more cues for attending
to EOLC domains and were more consistently preprinted and computerized than materials
used by physicians. Computerized forms concerning EOLC were uncommon. Across the
15 ICUs, there were opportunities to make EOLC- related materials more capable of
triggering and documenting specific EOLC clinical behaviors. CONCLUSIONS: Inclusion
of EOLC items on ICU formatted data entry forms and other materials capable of triggering
and documenting clinician behaviors is limited, particularly for physicians. Standardized
scales, protocols, and guidelines exist for many of the EOLC domains and should
be evaluated for possible use in ICUs. Whether such materials can improve EOLC has
yet to be determined.
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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation
dedicated to long-term changes in health care institutions to substantially improve
care for dying people and their families.