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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