Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients

Abstract

Objective: To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity.

Design: Descriptive observational study.

Setting: Five intensive care units.

Patients: One hundred sixteen family surrogate decisionmakers of long-stay intensive care unit patients who participated in an intensive communication system that aimed to provide weekly meetings with family decisionmakers. The structure of each meeting was to address medical update, patient preferences, treatment plan, and milestones for evaluating the treatment plan.

Interventions: None.

Measurements and main results: We audiotaped initial family meetings for 116 family decisionmakers for a total of 180 meetings. On average, meetings were 24 mins long with a majority of time being devoted to nonemotional speech and little (12%) spent discussing patient preferences. Quality of life was discussed in 45% and treatment limitation in 23% of all meetings. Quality-of-life discussions were more likely to occur when patients were admitted to a medical intensive care unit (odds ratio [OR] 5.9; p = .005), have a family decisionmaker who is a spouse (OR 9.4; p = .0001), were older (OR 1.04; p = 01), have a shorter length of stay (OR 0.93; p = .001), and have a family decisionmaker who was a spouse (OR 5.1; p = .002). For those with a treatment limitation discussion, 67% had a do-not-resuscitate order, 40% were admitted to a medical intensive care unit, 56% had a family decisionmaker who had been their caregiver, and 48% of their family decisionmakers were their children.

Conclusions: To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.

Figure 1

Comparison of percent time spent discussing key topics for first meetings where quality of life was discussed (n = 52) and first meetings where treatment limitation was discussed (n = 27). QOL, Quality of life; Tx Limit, treatment limitation; Tx, treatment.

Figure 2

Percentage of subjects who died inhospital (n = 24) or were discharged to an institutional setting (n = 85) who had either a quality of life or treatment limitation at their first family meeting. QOL, Quality of life; Treat Limit, treatment limitation.