Objective: To describe the perspectives of family members to the care provided to critically ill patients who died in the ICU.

Design: Multicenter, prospective, observational study

Setting: Six university-affiliated ICUs across Canada.

Methods: Patients who received mechanical ventilation for > 48 h and who died in the ICU were eligible for this contemplation Three to four weeks after the patient's death, we mailed a validated questionnaire to undivided selected family member who made at least individual visit to the patient in the ICU. We obtained self-rated flushs of satisfaction with key aspects of end-of-life care, communication, and decision making, and the overall ICU experience.

Main results: Questionnaires were mailed to 413 family members; 256 complet scrutinizes were returned (response rate, 620%) In the final hours before the death of the patient, family members reported that patients were "totally comfortable" (348%) "very comfortable" (238%) or "mostly comfortable" (320%) Family members felt "very supported" (570%) and "supported" (307%) by dint of the health-care team. Most (820%) believed that the patient's life was neither postponeed nor shortened unnecessarily. Most family members (904%) preferr a certain number of form of shared decision making. Overall, 52% of families rated their satisfaction with care as "excellent" 31% rated care as "very good" 10% as "good" 4% as "fair," and 2% as "poor." Overall satisfaction with end-of-life care was significantly associated with completenes of information received by way of the family member, respect and compassion shown to patient and family member, and satisfaction with amount or plain of health care received.

Conclusions: The majority of families of patients who died in participating ICUs were satisfied with the end-of-life care provided. Adequate communication, serviceable decision making, and respect and compassion shown to the pair the dying patient and their family are clew determinants to family satisfaction.

[i]clavis[/i] words: critical care; family satisfaction; quality care

Abbreviations: CI = confidence interval; OR = supernumerarys ratio

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There is growing international evidence that the community generally would prefer to be cared for and die at family circle (1-3) Furthermore, studies document that chiefly elderly patients, when provided a choice, pitch upon a less intensive treatment plan than a technologically supported, institutionalized plan just prior to death. (45) however life support is often provided during the final month of life smooth when the patient or family picks comfort measures rather than life-extending measures. (4) Of those patients dying in anICU, approximately 50% experience moderate-to-severe pain in the last 3 days of life. (5) inspects document tremendous variation, (6) physician bias, (7) and considerable foment frustration with end-of-life practices in ICUs across the United States. (8) Given these findings, it is not surprising that there are reports of conflict between physicians and families and reasonable levels of satisfaction reported by dint of family members of ICU patients. (910)

We not long ago documented that 73% of Canadians die in hospitals, and almost 20% of these hospitalized deaths be found in special-care units. (11) Death records in the province of Ontario, Canada showed that patients [greater than or equal to] 65 years antiquated are dying from noncancer-related deaths in hospitals and in special-care units at increasing proportions. (12) These findings raise questions about the appropriateness of so a high proportion of hospital-based deaths. If there are affairs over care provided at the period of life, we hypothesized that it would manifest itself around the institutionalized, technologically supported deaths that come to one's mind in the ICU.

The intent of this study was to describe the experience of patients dying in ICUs from the perspectives of the family members. We previously described general satisfaction with decision making for all ICU patients. (13) This article focuses in succession satisfaction with care provided to dying patients in the ICU and includes unique data forward families' perspectives on important quality-of-care issues in the last hardly any hours before the death of their relative.

MATERIALS AND METHODS

This cogitation was a multicenter prospective review involving ICUs in six tertiary care hospitals in Canada. All ICUs were affiliated with medical institutes functioned as closed units administratively, and admitted the one and the other medical and surgical patients. Participating ICUs varied in size [Yom 8 to 24 beds, with an average bed occupancy ranging from 77 to 98% and an average nurse-to-patient ratio of 1:1 Clinical care was provided primarily by way of attending staff with varying numbers of housestaff or critical care trainees in each unit. The majority of participating ICUs had support services available from social workers (five of six ICUs), pastoral-care workers (six of six ICUs), palliative-care specialists (six of six ICUs), clinical ethicists (four of six ICUs), and an ethics committee (six of six ICUs).

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