Did the Quality of ICU End-of-Life Care Suffer During the COVID-19 Pandemic? (GP710)

Abstract

Outcomes1. Learn the components of the Bereaved Family Survey and what it measures2. Describe whether there were changes in end-of-life care ratings after the pandemic startedImportanceGiven strained resources and visitation restrictions, families might have perceived lower-quality end-of-life (EOL) care during the COVID-19 pandemic.Objective(s)We compared families’ ratings of EOL care before and during the COVID-19 pandemic.Method(s)Next-of-kin (NOKs) of patients who died in the ICUs of a two-hospital healthcare system between July 2019 and April 2021 were asked to complete a modified Bereaved Family Survey (BFS). We compared care quality reports for patients who died before and during the pandemic using single-item questions and two measures derived from the BFS: Respectful Care and Communication (5 items, alpha = 0.82) and Emotional and Spiritual Support (3 items, alpha = 0.77). Multivariable regression was used to adjust for demographic and clinical characteristics.ResultsOf 1,029 patients who died in the ICU during the study period, 133 of 388 (34%) NOKs completed the survey before the pandemic and 181 of 639 (28%) during the pandemic. Among those for whom surveys were received, pandemic decedents had higher sequential organ failure assessment score on ICU admission (8.0 vs 6.0, p < 0.01), fewer palliative care consultations (28% vs 40%, p = 0.03), and fewer advance directives (30% vs 44%, p < 0.01) than decedents before the pandemic. In multivariate analysis, NOKs of pandemic decedents more frequently reported that they were notified of impending death (90.6% vs 79.7%, p < 0.01). There was no difference in the global rating of EOL care (63.2% vs 63% rating it as excellent, p = 0.59) or Emotional and Spiritual Support or Respectful Care and Communication factors.Conclusion(s)Despite visitation restrictions, the modified BFS did not detect a difference in families’ overall ratings of quality of EOL care in the ICU among decedents before and during the pandemic.ImpactOur study shows that the quality of EOL care can be preserved during periods of stress such as the COVID-19 pandemic.