Abstract
Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes. Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss. This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference. Physical and mental HRQOL were worse in the 3 more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the 3 poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators. Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.
Published Version
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