End of life in the critically ill patient: evaluation of experience of end of life by caregivers (EOLE study)

SRLF Trial Group, Nadia Aissaoui, Virginie Amilien, Nadiejda Antier, Adrien Auvet, Elie Azoulay, Saber Davide Barbar, Florent Bavozet, Asael Berger, Sami Blidi, Florence Boissier, Pierre Bouju, Yannick Brunin, Bertrand Canoville, Maguelone Chalies, Frank Chemouni, David Couret, Marc Danguy, Cédric Daubin, Guillaume Decormeille, Alexandre Demoule, Julien Duvivier, Stephan Ehrmann, Etienne Escudier, Pierre Esnault, Arnaud Galbois, Mathieu Guilbart, David Grimaldi, Nicholas Heming, Alexandre Herbland, Bertrand Hermann, Clément Hoffmann, Stéphanie Houcke, Sami Hraeich, Frédéric Jacobs, Gwenaelle Jacq, Amira Jamoussi, Sébastien Jochmans, Nancy Kentish-Barnes, Jean-Claude Lacherade, Fabien Lambiotte, Jean-Baptiste Lascarrou, Gabriel Lejour, Jean-François Llitjos, Cécile Lory, Guillaume Louis, Estelle Martin, Philippe Mateu, Jonathan Messika, Philippe Michel, Jean-Paul Mira, Sébastien Moschietto, Grégoire Muller, Lamia Ouanes-Besbes, François Philippart, Michael Piagnerelli, Gael Piton, Gaetan Plantefeve, Laurent Poiroux, Jean-Pierre Quenot, Jean Reignier, Anne Renault, René Robert, Arnaud Sement, Pierre-Yvan Simonoviez, Anne Terrier, Martial Thyrault, Jean Turc, Thierry Vanderlinden, Atika Youssoufa, SRLF Trial Group, Nadia Aissaoui, Virginie Amilien, Nadiejda Antier, Adrien Auvet, Elie Azoulay, Saber Davide Barbar, Florent Bavozet, Asael Berger, Sami Blidi, Florence Boissier, Pierre Bouju, Yannick Brunin, Bertrand Canoville, Maguelone Chalies, Frank Chemouni, David Couret, Marc Danguy, Cédric Daubin, Guillaume Decormeille, Alexandre Demoule, Julien Duvivier, Stephan Ehrmann, Etienne Escudier, Pierre Esnault, Arnaud Galbois, Mathieu Guilbart, David Grimaldi, Nicholas Heming, Alexandre Herbland, Bertrand Hermann, Clément Hoffmann, Stéphanie Houcke, Sami Hraeich, Frédéric Jacobs, Gwenaelle Jacq, Amira Jamoussi, Sébastien Jochmans, Nancy Kentish-Barnes, Jean-Claude Lacherade, Fabien Lambiotte, Jean-Baptiste Lascarrou, Gabriel Lejour, Jean-François Llitjos, Cécile Lory, Guillaume Louis, Estelle Martin, Philippe Mateu, Jonathan Messika, Philippe Michel, Jean-Paul Mira, Sébastien Moschietto, Grégoire Muller, Lamia Ouanes-Besbes, François Philippart, Michael Piagnerelli, Gael Piton, Gaetan Plantefeve, Laurent Poiroux, Jean-Pierre Quenot, Jean Reignier, Anne Renault, René Robert, Arnaud Sement, Pierre-Yvan Simonoviez, Anne Terrier, Martial Thyrault, Jean Turc, Thierry Vanderlinden, Atika Youssoufa

Abstract

Background: The death rate in intensive care units (ICUs) can reach 20%. More than half occurs after a decision of care withholding/withdrawal. We aimed at describing and evaluating the experience of ICU physicians and nurses involved in the end-of-life (EOL) procedure. Primary objective was the evaluation of the experience of EOL assessed by the CAESAR questionnaire. Secondary objectives were to describe factors associated with a low or high score and to examine the association between Numeric Analogic Scale and quality of EOL.

Methods: Consecutive adult patients deceased in 52 ICUs were included between April and June 2018. Characteristics of patients and caregivers, therapeutics and care involved after withdrawal were recorded. CAESAR score included 15 items, rated from 1 (traumatic experience) to 5 (comforting experience). The sum was rated from 15 to 75 (the highest, the best experience). Numeric Analogic Scale was rated from 0 (worst EOL) to 10 (optimal EOL).

Results: Five hundred and ten patients were included, 403 underwent decision of care withholding/withdrawal, and among them 362 underwent effective care withdrawal. Among the 510 patients, mean CAESAR score was 55/75 (± 6) for nurses and 62/75 (± 5) for physicians (P < 0.001). Mean Numeric Analogic Scale was 8 (± 2) for nurses and 8 (± 2) for physicians (P = 0.06). CAESAR score and Numeric Analogic Scale were significantly but weakly correlated. They were significantly higher for both nurses and physicians if the patient died after a decision of withholding/withdrawal. In multivariable analysis, among the 362 patients with effective care withdrawal, disagreement on the intensity of life support between caregivers, non-invasive ventilation and monitoring and blood tests the day of death were associated with lower score for nurses. For physicians, cardiopulmonary resuscitation the day of death was associated with lower score in multivariable analysis.

Conclusion: Experience of EOL was better in patients with withholding/withdrawal decision as compared to those without. Our results suggest that improvement of nurses' participation in the end-of-life process, as well as less invasive care, would probably improve the experience of EOL for both nurses and physicians. Registration: ClinicalTrial.gov: NCT03392857.

Keywords: Critical care; End of life; Withdrawal treatment; Withholding treatment.

Conflict of interest statement

The authors declare that they have no competing interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
A Correlation between CAESAR score and Numeric Analogic Scale for physicians. B Correlation between CAESAR score and Numeric Analogic Scale for nurses
Fig. 2
Fig. 2
A Factors associated with nurses’ CAESAR score in multivariable analysis with random-effect multilevel logistic regression (Forest plot). B Factors associated with physicians’ CAESAR score in multivariable analysis with random-effect multilevel logistic regression (Forest plot)

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Source: PubMed

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