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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been made that life and organ support was no longer feasible or appropriate and that these therapies were going to be withdrawn or withheld and that the likelihood of death was high 44 (37)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)
  1. DNACPR do not attempt cardiopulmonary resuscitation.
  2. * Symptom control by interventions delivered by any medical team, not just specialist palliative care team.
  3. ** Often referred for more than one reason.