An interprofessional multicomponent intervention to improve end-of-life care in intensive care: A before-and-after study

Tania Lovell; Marion Mitchell; Madeleine Powell; Petra Strube; Angela Tonge; Kylie O'Neill; Elspeth Dunstan; Amity Bonnin-Trickett; Elizabeth Miller; Adam Suliman; Tamara Ownsworth; Kristen Ranse

doi:10.1016/j.aucc.2024.101147

An interprofessional multicomponent intervention to improve end-of-life care in intensive care: A before-and-after study

Aust Crit Care. 2024 Dec 16:101147. doi: 10.1016/j.aucc.2024.101147. Online ahead of print.

Authors

Affiliations

¹ Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Queensland, Australia. Electronic address: Tania.Lovell@health.qld.gov.au.
² Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia.
³ National Drug and Alcohol Research Centre, School of Population Health, University of New South Wales, NSW, Australia.
⁴ Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Queensland, Australia.
⁵ School of Applied Psychology and the Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Australia.
⁶ School of Nursing & Midwifery, Griffith University, Queensland, Australia.

PMID: 39689996
DOI: 10.1016/j.aucc.2024.101147

Abstract

Background: The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.

Objectives: This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians' perceptions of EOLC.

Methods: A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann-Whitney U tests for non-normally distributed data.

Findings: A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t₂₈₂ = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians' work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.

Conclusions: The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.

Keywords: Critical care; End-of-life; End-of-life care; Family-centred care; Intensive care; Nursing.