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. 2022 May 18;22(1):151.
doi: 10.1186/s12871-022-01684-8.

A beginner's view of end of life care on German intensive care units

Timur Sellmann  1   2 , Muhammad Abu Alneaj  3 , Dietmar Wetzchewald  3 , Heidrun Schwager  3 , Christian Burisch  4 , Serge C Thal  5   6 , Tienush Rassaf  7 , Manfred Weiss  8 , Stephan Marsch  9 , Frank Breuckmann  7
Affiliations

A beginner's view of end of life care on German intensive care units

Timur Sellmann et al. BMC Anesthesiol. .

Abstract

Background: Little is known about importance and implementation of end-of-life care (EOLC) in German intensive care units (ICU). This survey analyses preferences and differences in training between "medical" (internal medicine, neurology) and "surgical" (surgery, anaesthesiology) residents during intensive care rotation.

Methods: This is a point-prevalence study, in which intensive care medicine course participants of one educational course were surveyed. Physicians from multiple ICU and university as well as non-university hospitals and all care levels were asked to participate. The questionnaire was composed of a paper and an electronic part. Demographic and structural data were prompted and EOLC data (48 questions) were grouped into six categories considering importance and implementation: category 1 (important, always implemented), 2 (important, sometimes implemented), 3 (important, never implemented) and 4-6 (unimportant, implementation always, sometimes, never). The trial is registered at the "Deutsches Register für klinische Studien (DRKS)", Study number DRKS00026619, registered on September 10th 2021, www.drks.de .

Results: Overall, 194/ 220 (88%) participants responded. Mean age was 29.7 years, 55% were female and 60% had scant ICU working experience. There were 64% medical and 35% surgical residents. Level of care and size of ICU differed significantly between medical and surgical (both p < 0.001). Sufficient implementation was stated for 66% of EOLC questions, room for improvement (category 2 and 3) was seen in 25, and 8% were classified as irrelevant (category 6). Areas with the most potential for improvement included prognosis and outcome and patient autonomy. There were no significant differences between medical and surgical residents.

Conclusions: Even though EOLC is predominantly regarded as sufficiently implemented in German ICU of all specialties, our survey unveiled still 25% room for improvement for medical as well as surgical ICU residents. This is important, as areas of improvement potential may be addressed with reasonable effort, like individualizing EOLC procedures or setting up EOLC teams. Health care providers as well as medical societies should emphasize EOLC training in their curricula.

Keywords: Advanced care planning; Critical care; Education, medical, graduate; Palliative care; Prognosis; Quality of life; Surveys and questionnaires; Terminal care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Interdisciplinary distribution of category 2 (“improvable”) questions. Figure 1 shows a score cloud according to the corresponding number of mentions, first for the total collective, then for the “surgical” and “medical” subpopulations. From a purely visual point of view, there are no significantly noticeable differences in the different response behaviour
See this image and copyright information in PMC

References

    1. Marckmann G, Neitzke G, Schildmann J, Michalsen A, Dutzmann J, Hartog C, Jöbges S, Knochel K, Michels G, Pin M, Riessen R, Rogge A, Taupitz J, Janssens U. Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic: Clinical andethical recommendations of DIVI, DGINA, DGAI, DGIIN, DGNI, DGP, DGP and AEM. German version. Med Klin Intensivmed Notfmed. 2020;115(6):477–85. 10.1007/s00063-020-00708-w. - PMC - PubMed
    1. Weiss M, Michalsen A, Toenjes A, Porzsolt F, Bein T, Brinkmann A, et al. Structural aspects regarding end-of-life care in German intensive care units managed by anaesthesiologists. Anaesth Intensivmed. 2018;59:122–131.
    1. Weiss M, Michalsen A, Toenjes A, Porzsolt F, Bein T, Theisen M, et al. End-of-life perceptions among physicians in intensive care units managed by anesthesiologists in Germany: a survey about structure, current implementation and deficits. BMC Anesthesiol. 2017;17(1):93. doi: 10.1186/s12871-017-0384-5. - DOI - PMC - PubMed
    1. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med. 2015;175(3):363–371. doi: 10.1001/jamainternmed.2014.7386. - DOI - PubMed
    1. Long AC, Brumback LC, Curtis JR, Avidan A, Baras M, De Robertis E, et al. Agreement with consensus statements on end-of-life care: a description of variability at the level of the provider, hospital, and country. Crit Care Med. 2019;47(10):1396–1401. doi: 10.1097/CCM.0000000000003922. - DOI - PMC - PubMed

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