Instruments to evaluate patient/family care and satisfaction at the end-of-life in an intensive care unit (ICU) are limited. The Quality of Dying and Death Questionnaire (QODD) and the Critical Care Family Satisfaction Survey (CCFSS) are tools that have been validated in different populations. The goal of this study was to correlate the results of the Family and Nurse QODD and CCFSS for patients who died in a multi-specialty ICU.
This study took place in a 28-bed medical, surgical, and trauma ICU of a 610-bed community-based, tertiary referral center. As part of ongoing quality improvement, the CCFSS is given to families upon discharge from the ICU while the QODD is distributed within two weeks of discharge to families of patients who die in our ICU. Using Pearson’s correlation, total scores for the Family and Nurse QODD were compared to the total score and subscales of the CCFSS. Correlation was significant at the 2-tailed, 0.01 level.
Between 3/1/04 and 4/30/04, 182 deaths occurred in the ICU’s of which 159 (87%) of the families and nurses received the QODD and 180 (99%) received the CCFSS. Return rates were variable (19.4%, CCFSS; 51.9% Family QODD; 63.5% Nurse QODD). There were 26 matching sets of QODD and CCFSS. There was poor correlation between the Family and Nurse QODD (r = 0.422, p = 0.05). The Family QODD correlated well with the CCFSS information subscale (r = 0.598, p = 0.019), but in general the Family QODD and Nurse QODD did not correlate with the CCFSS total score (r = -0.086 and r = 0.006, respectively).
(1) Incompleteness and low return rates make survey methodology as part of quality improvement in ICU challenging (2) the Family and Nurse QODD may not be interchangeable as quality indicators for the end-of-life care, and (3) family perception of quality care during the dying process is associated with satisfaction with information.
Continued validation of the QODD and CCFSS is needed.
Daniel Ray, None.