Seaman, Jennifer Burgher
(2014)
Patient-Centered Outcomes and Use of Palliative Care Among Seriously-Ill and Non-Surviving Mechanically Ventilated ICU Patients.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
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Abstract
Background: A considerable proportion of mechanically ventilated (MV) patients in the ICU are at high risk of dying or die during hospitalization. Patients face threats to comfort, social connectedness, and dignity as a result of experiencing pain, ICU-acquired pressure ulcers, heavy sedation, and physical restraint, all inconsistent with standards for high quality end-of-life (EOL) care. Receipt of palliative care consultation (PCC) services has been associated with improved outcomes for seriously-ill and dying individuals.
Objectives: 1) Describe patient-centered outcomes (unrelieved pain, ICU-acquired pressure ulcers, heavy sedation and days in restraint) among sampled patients who were seriously-ill or non-surviving; 2) Identify patient-level predictors of these outcomes; and 3) Explore the relationship between presence, timing and duration of PCC services and patient outcomes among sampled patients who were seriously-ill or non-surviving.
Methods: A retrospective cohort design was used to conduct an expanded secondary analysis of data from the parent study (SPEACS-2; RWJF INQRI #66633). Additional data on receipt of PCC services were abstracted from the electronic medical records of parent study subjects.
Results: Of the 1440 sampled patients, 773 were at high risk of dying or did not survive hospitalization. This cohort had a mortality rate of 29.8%; and of ICU days evaluated in the parent study, they spent on average 50% with unrelieved pain, 40% with some heavy sedation, and 40.8% with physical restraint. 12.3% experienced at least one ICU-acquired pressure ulcer. Being at EOL was independently associated with greater odds of experiencing heavy sedation (OR=2.64) and ICU-acquired pressure ulcer (OR=1.60); greater percentage of the ICU stay in heavy sedation (b=0.088; p< .001); and lower percentage of ICU days with unrelieved pain (b=-0.063; p=.002), after adjusting demographic and clinical covariates. Among those at EOL, 73 (9.4%) received PCC services, occurring on average, after 62% of the stay had elapsed. Compared to pre-consultation, subjects post consultation experienced a lower proportion of days in restraint (-0.17, p<.001), a higher proportion of days in heavy sedation (0.13, p=.015), and similar proportions of days with pain.
Conclusion: These findings suggest that seriously-ill and non-surviving MV adults in the ICU experience a high prevalence of poor outcomes on measures of patient-centered care.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
18 December 2014 |
| Date Type: |
Publication |
| Defense Date: |
10 December 2014 |
| Approval Date: |
18 December 2014 |
| Submission Date: |
15 December 2014 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
153 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
End-of-Life Care
Patient-centered Outcomes
Palliative Care
Critical Care
Quality of Dying
Intensive Care Unit |
| Date Deposited: |
18 Dec 2014 15:41 |
| Last Modified: |
15 Nov 2016 14:26 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/23886 |
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