Family perceptions of end-of-life care in an urban ICU.

OBJECTIVES: As most Canadians die in hospital, the final contact of family members with their loved ones is frequently in an unknown and uncomfortable environment. Family members are integral to the end-of-life decision-making process and are vital contributors to the comfort of dying patients. A quantitative study was conducted in three critical care areas where the stated goals were to provide not only quality care to patients, but also support to families. The researchers sought to determine levels of satisfaction with care, visitation, support, comfort and pain measures.

METHOD: Three hundred surveys were mailed to next of kin who had a loved one die in the critical care areas of an urban tertiary care centre within the prior three years. Survey questions covered such issues as perceptions regarding the decision to stop life supports, access to the patient, access to physicians and nurses and information regarding the patient's status, support provided by the hospital, and organ donation attitudes.

FINDINGS: Multiple regression analysis revealed that three factors predicted perceptions of overall quality of care: 1) being informed by nurses and physicians of any changes, 2) having the same group of nurses provide care, and 3) having one individual act as the family contact. Together these factors accounted for 52% of the variance in perceptions of care. Two factors accounted for 59% of the variance in dissatisfaction with the information received: 1) the perception that physicians did not spend enough time answering family questions, and 2) that the family was not present when the patient died.

IMPLICATIONS: Consistency in nursing care and provision of information to family members may be difficult in the fast pace of an ICU, but are reasonable program objectives considering the positive influence this has on perceptions of care. Further, flexible visitation policies which maximize access between family members and both their dying loved one and health care professionals appear to have a beneficial effect on satisfaction.