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Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff

A Multicenter Cross-Sectional Survey

Cho, Jun Yeun MD1; Park, Ju-Hee MD2; Kim, Junghyun MD3; Lee, Jinwoo MD4; Park, Jong Sun MD, PhD5; Cho, Young-Jae MD, PhD5; Yoon, Ho Il MD, PhD5; Lee, Sang-Min MD, PhD4; Lee, Jae-Ho MD, PhD5; Lee, Choon-Taek MD, PhD5; Lee, Yeon Joo MD5

doi: 10.1097/CCM.0000000000003853
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Objectives: Facilitating a high quality of death is an important aspect of comfort care for patients in ICUs. The quality of death in ICUs has been rarely reported in Asian countries. Although Korea is currently in the early stage after the implementation of the “well-dying” law, this seems to have a considerable effect on practice. In this study, we aimed to understand the status of quality of death in Korean ICUs as perceived by medical staff, and to elucidate factors affecting patient quality of death.

Design: A multicenter cross-sectional survey study.

Setting: Medical ICUs of two tertiary-care teaching hospitals and two secondary-care hospitals.

Patients: Deceased patients from June 2016 to May 2017.

Interventions: Relevant medical staff were asked to complete a translated Quality of Dying and Death questionnaire within 48 hours after a patient’s death. A higher Quality of Dying and Death score (ranged from 0 to 100) corresponded to a better quality of death.

Measurements and Main Results: Total 416 completed questionnaires were obtained from 177 medical staff (66 doctors and 111 nurses) of 255 patients. All 20 items of the Quality of Dying and Death received low scores. Quality of death perceived by nurses was better than that perceived by doctors (33.1 ± 18.4 vs 29.7 ± 15.3; p = 0.042). Performing cardiopulmonary resuscitation and using inotropes within 24 hours before death were associated with poorer quality of death, whereas using analgesics was associated with better quality of death.

Conclusions: The quality of death of patients in Korean ICUs was considerably poorer than reported in other countries. Provision of appropriate comfort care, avoidance of unnecessary life-sustaining care, and permission for more frequent visits from patients’ families may correspond to better quality of death in Korean medical ICUs. It is also expected that the new legislation would positively affect the quality of death in Korean ICUs.

1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju-si, Republic of Korea.

2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea.

4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. J. Y. Cho received funding from Seoul National University Bundang Hospital research grant.

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Yeon Joo Lee, MD, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. E-mail: yjlee1117@snubh.org

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