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. 2020 Aug 25;24(1):521.
doi: 10.1186/s13054-020-03191-z.

Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Florence Boissier  1   2 , Valérie Seegers  3 , Amélie Seguin  4 , Stéphane Legriel  5 , Alain Cariou  6   7 , Samir Jaber  8   9   10 , Jean-Yves Lefrant  11   12 , Thomas Rimmelé  13   14 , Anne Renault  15 , Isabelle Vinatier  16 , Armelle Mathonnet  17 , Danielle Reuter  18 , Olivier Guisset  19 , Christophe Cracco  20 , Jacques Durand-Gasselin  21 , Béatrice Éon  22 , Marina Thirion  23 , Jean-Philippe Rigaud  24 , Bénédicte Philippon-Jouve  25 , Laurent Argaud  26   27 , Renaud Chouquer  28 , Laurent Papazian  29   30 , Céline Dedrie  31 , Hugues Georges  32 , Eddy Lebas  33 , Nathalie Rolin  34 , Pierre-Edouard Bollaert  35   36 , Lucien Lecuyer  37 , Gérald Viquesnel  38 , Marc Leone  30   39 , Ludivine Chalumeau-Lemoine  40 , Maité Garrouste-Orgeas  41 , Elie Azoulay  18   42 , Nancy Kentish-Barnes  43   44   45
Affiliations

Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

Florence Boissier et al. Crit Care. .

Abstract

Background: As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient's and/or the relatives' experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study.

Methods: Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort.

Results: Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside.

Conclusion: We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.

Keywords: Caregivers; Death; End-of-life experience; Intensive care unit.

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Conflict of interest statement

None of the authors declare any conflict of interest in relation to this manuscript.

Figures

Fig. 1
Fig. 1
Distribution of the global CAESAR-P and CAESAR-N scores. Histograms: dark gray, score < 45; gray, score 45–60; light gray, score > 60
Fig. 2
Fig. 2
Psychometric validation of the CAESAR-P and CAESAR-N. The factorial analyses and their corresponding scree plots are presented in a and b. In both cohorts and in both questionnaires, the first factor on its own explained a substantial amount of the item variance and no other factor appears of comparable importance, compared to the value of simulations. The scale is thus fairly homogeneous, if not strictly unidimensional
See this image and copyright information in PMC

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