Table 4 Quality markers for EOLC on the ICU
From: Quality of transition to end-of-life care for cancer patients in the intensive care unit
Quality markers for end-of-life care on the intensive care unit | % (N/total N) |
|---|---|
Symptom management and comfort care | |
Documented evidence of need for symptom control as evidenced by the documented evidence of symptoms such as pain, shortness of breath, anxiety, nausea, vomiting, constipation | 71 (27/38) |
Documented evidence of successful symptom control (N = 27)* | 79 (21/27) |
Documented evidence that the patient was reviewed by the hospital specialist palliative care team | 53(20/38) |
Reason for referral to hospital specialist palliative care team (N = 20)** | |
Symptom control | 80 (16/20) |
EOLC | 80 (16/20) |
Psychosocial support | 25 (5/20) |
Communication with team, patient and family | |
Documented evidence that a professional decision had been made that life and organ support was no longer feasible or appropriate and that these therapies were going to be withdrawn or withheld and that the likelihood of death was high | 44 (37) |
Is there documented evidence that this decision had been discussed with the patient, relative and oncology team | |
Discussed with patient | 43 (16/37) |
Not possible to discuss with patient being too unwell | 51 (19/37) |
No record of whether or not discussed with patient | 5 (2/37) |
Discussed with relative | 97 (36/37) |
Discussed with parent oncology team | 92 (34/37) |
Documented evidence that a professional decision had been made that the patient should not be for cardiopulmonary resuscitation in the event of a cardiopulmonary arrest (DNACPR order completed) | 44 (37) |
Documented evidence that this decision was: | |
Discussed with patient | 41 (15/37) |
Not possible to discuss with patient as too unwell | 41 (15/37) |
No record of whether or not discussed with patient | 19 (7/37) |
Discussed with relative | 89 (33/37) |
Discussed with parent oncology team | 73 (27/37) |
Patient- and family-centred decision-making | |
Documented evidence that the patient had an advance directive or an Advanced Decision to Refuse Treatment in place | 0 (0/38) |
Documented evidence about the patient’s wishes and preferences for their preferred place of death | 11 (4/38) |
Emotional and practical support | |
Documented evidence that psychological support was offered to the patient | 29 (11/38) |
Documented evidence that psychological support was offered to relatives | 21 (8/38) |
Documented evidence that practical and welfare advice (e.g. about welfare benefits/accommodation) was offered to the patient/relatives | 21 (8/38) |
Spiritual support | |
Documented evidence that a discussion took place with the patient or family regarding their spiritual needs or that chaplaincy support was offered | 37 (14/38) |