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193 PREDICTORS OF FAMILY SATISFACTION WITH DECISION-MAKING FOR PATIENTS WHO DIE IN THE INTENSIVE CARE UNIT.
  1. C. J. De Ruiter,
  2. R. A. Engelberg,
  3. R. J. Wall,
  4. J. R. Curtis
  1. University of Washington, Seattle, WA

Abstract

Objective To identify patient, family and hospital course characteristics that predict satisfaction with decision-making among families of patients who died in the intensive care unit (ICU).

Methods A validated questionnaire measuring satisfaction with ICU decision-making was administered at 9 medical centers to family members of all patients who died during their ICU stay or within 24 hours of ICU discharge. A validated summary score for satisfaction with decision-making and scores on two individual items were used as outcomes. Exploratory analyses using Spearman correlation coefficients identified significant predictors of satisfaction with decision making (p < .05).

Results Analyses were completed for 151 families with returned questionnaires and medical record abstraction data. Satisfaction with decision-making was correlated with older family member age (r = .226), a do-not-resuscitate (DNR) order (r = .203), and spiritual support in the first or last 72 hours (r = .207; r = .173). Feeling supported in the decision-making process was associated with a DNR order (r = .220), terminal discontinuation of mechanical ventilation (r = .187), patient/family desire to withdraw support in the last 72 hours (r = .214), having health insurance (r = .164), and dying without life support (r = .195). Feeling control over patient care was associated with increased patient age (r = .165), terminal discontinuation of mechanical ventilation (r = .224), patient/family desire to withdraw support in the first or last 72 hours (r = .205; r = .181), spiritual support in the last 72 hours (r = .194) and dying without life support (r = .177).

Conclusions When patients die in the ICU, family satisfaction with decision-making is positively associated with implementation of a DNR order, spiritual support, and the decision to withdraw life support. Focusing on these aspects of care may improve family satisfaction when patients die in the ICU.

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