Palliative Care Training Program Fails to Improve Quality of Care

A quality improvement program designed to improve end-of-life care in the ICU failed to yield any positive effects on quality of dying or length of stay, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

Researchers from the University of Washington, Seattle, WA, found that a palliative care training program had no impact on how much time patients spent in the ICU before dying, and that interventions failed to reduce the time between ICU to the end of mechanical ventilation.

In the study, J. Randall Curtis, MD, and colleagues conducted a cluster-randomized trial of 12 hospitals, targeting five interventions: clinician education, local champions, academic detailing, clinician feedback of quality data, and system supports. They assessed outcomes in patients dying in the ICU or within 30 hours of ICU discharge using surveys and medical-record review, and asked families and nurses to complete Quality of Dying and Death (QODD) and satisfaction surveys.

Curtis and colleagues collected data during baseline and follow-up at each hospital, and used regression models to test for intervention effects, controlling for site, patient, family, and nurse characteristics. The training program included grand rounds lectures, pamphlets for clinicians and family members, and feedback on patient care from family members and nurses.

According to researchers, all 12 hospitals completed the trial, with 2,318 eligible patients and target sample sizes obtained for family and nurse surveys. The primary outcome, family-QODD, demonstrated no change with the intervention, and there was no change in family satisfaction or nurse-QODD. There was also a non-significant increase in ICU days prior to death following the intervention; among patients undergoing withdrawal of mechanical ventilation, no changes in time was noted from admission to withdrawal.

The intervention, they concluded, “was associated with no improvement in quality of dying and no change in ICU length of stay prior to death or time from ICU admission to withdrawal of life-sustaining measures. Improving ICU end-of-life care will require interventions with more direct contact with patients and family.”

For more:

• Early Palliative Care Improves Quality of Life, Survival
• Honesty Is the Best Policy: Effective Communication is Essential for Achieving a Good Death
• Hospitalists and Palliative Care: A Natural Alliance