Heyland and colleagues deserve congratulations for their study, “Dying in the Intensive Care Unit: Perspectives of Family Members” in this issue of CHEST (see page 392). In this multicenter study conducted at tertiary care centers, the authors documented the fact that 83% of family members were satisfied with the care that their loved ones received. The authors credit the good communications, decision making, respect, and compassion shown in the care of patients and their families for these results. The experience of the American investigators has been much less satisfactory than their Canadian counterparts. Lynn and colleagues1
reported in 1997 on the larger Study To Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) and the Hospitalized Elderly Longitudinal Project. They were less sanguine about their findings. On interviewing surrogates of the elderly or seriously ill patients who had died within a year of the hospitalization, they found that almost 60% of patients would have preferred comfort care. They also discovered that in 10% of the cases, care was contrary to the preferred approach. The 11% rate of attempted resuscitation was almost four times higher than the 3% rate in the study by Heyland et al. The SUPPORT study revealed that one third of the patients were in unexpected pain at the time of death vs good pain management found in 90% of Canadian patients.