A large portion of deaths in the U.S. occurs in the intensive care unit (ICU) or after a stay in the ICU. There is mounting evidence of problems in the quality of care these patients and their families receive, although much of this evidence comes from academic medical centers. This proposal is a competitive renewal of our previous 2-year R01 that examined the quality of clinician-family communication about end-of-life care in the ICU. In the prior grant, we identified specific shortcomings in patient-clinician communication and discovered that an intervention to improve this communication cannot exclusively target the ICU family conference. Based on the findings of the prior grant, this competitive renewal application proposes to evaluate an organizational, nurse-focused intervention to improve end-of-life care in the ICU with 5 components: 1) nurse, physician, and respiratory therapist education regarding the principles and practice of palliative care in the ICU; 2) academic detailing nurse, physician, and respiratory therapist directors identifying and addressing local barriers to quality end-of-life care; 3) implementation of standardized """"""""withdrawal of life support"""""""" order forms and family pamphlets; 4) guidance from local nurse, physician, and respiratory therapist champions; and 5) feedback of local quality improvement data in comparison to the aggregated ratings at the other sites. The intervention will be evaluated in a randomized, controlled trial with the hospital as the unit of randomization and the hospital and the ICUs as the target of the intervention. The outcomes include: a) the previously validated """"""""Quality of Dying and Death"""""""" questionnaires assessed by families and nurses, b) satisfaction with care assessed by the families and nurses, and c) indicators of quality of care assessed by nurses and from medical record review. The primary outcome is family-assessed """"""""Quality of Dying and Death"""""""". Statistical analyses use generalized estimating equations to allow analysis of patient-level data while controlling for the clustering within units and hospitals. The goal of this proposal is to demonstrate the effectiveness of a generalizable, multi-faceted, nurse-focused quality improvement project designed to improve end-of-life care in the ICU.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR005226-07
Application #
7179318
Study Section
Nursing Research Study Section (NURS)
Program Officer
Aziz, Noreen M
Project Start
1999-09-30
Project End
2008-02-29
Budget Start
2007-03-01
Budget End
2008-02-29
Support Year
7
Fiscal Year
2007
Total Cost
$580,144
Indirect Cost
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Isaac, Margaret; Curtis, J Randall (2017) How to respond to an ICU patient asking if she/he is going to die. Intensive Care Med 43:220-222
Dotolo, Danae; Nielsen, Elizabeth L; Curtis, J Randall et al. (2017) Strategies for Enhancing Family Participation in Research in the ICU: Findings From a Qualitative Study. J Pain Symptom Manage 54:226-230.e1
Long, Ann C; Downey, Lois; Engelberg, Ruth A et al. (2017) Understanding Response Rates to Surveys About Family Members' Psychological Symptoms After Patients' Critical Illness. J Pain Symptom Manage 54:96-104
Khandelwal, Nita; Benkeser, David; Coe, Norma B et al. (2016) Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator. Ann Am Thorac Soc 13:2190-2196
Downey, Lois; Hayduk, Leslie A; Curtis, J Randall et al. (2016) Measuring Depression-Severity in Critically Ill Patients' Families with the Patient Health Questionnaire (PHQ): Tests for Unidimensionality and Longitudinal Measurement Invariance, with Implications for CONSORT. J Pain Symptom Manage 51:938-46
Ramos, Kathleen J; Downey, Lois; Nielsen, Elizabeth L et al. (2016) Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care. J Palliat Med 19:292-9
Curtis, J Randall; Downey, Lois; Engelberg, Ruth A (2016) The importance and challenge of measuring family experience with end-of-life care in the ICU. Intensive Care Med 42:1179-81
Brown, Crystal E; Engelberg, Ruth A; Nielsen, Elizabeth L et al. (2016) Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer. Ann Am Thorac Soc 13:684-9
Curtis, J Randall; Treece, Patsy D; Nielsen, Elizabeth L et al. (2016) Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care. Am J Respir Crit Care Med 193:154-62
Khandelwal, Nita; Benkeser, David; Coe, Norma B et al. (2016) Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions. J Palliat Med 19:1171-1178

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