Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study.

Publication ,  Journal Article
Cox, CE; Olsen, MK; Parish, A; Gu, J; Ashana, DC; Pratt, EH; Haines, K; Ma, J; Casarett, DJ; Al-Hegelan, MS; Naglee, C; Katz, JN; O'Keefe, YA ...
Published in: BMJ Support Palliat Care
September 27, 2022

OBJECTIVE: Because the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care needs exist. METHODS: Prospective cohort study conducted among family members of adult patients undergoing mechanical ventilation in six medical and surgical ICUs. The primary outcome was palliative care need measured by the Needs at the End-of-Life Screening Tool (NEST, range from 0 (no need) to 130 (highest need)) completed 3 days after ICU admission. We also assessed quality of communication, clinician-family relationship and patient centredness of care. Latent class analysis of the NEST's 13 items was used to identify groups with similar patterns of serious palliative care needs. RESULTS: Among 257 family members, latent class analysis yielded a four-class model including complex communication needs (n=26, 10%; median NEST score 68.0), family spiritual and cultural needs (n=21, 8%; 40.0) and patient and family stress needs (n=43, 31%; 31.0), as well as a fourth group with fewer serious needs (n=167, 65%; 14.0). Interclass differences existed in quality of communication (median range 4.0-10.0, p<0.001), favourable clinician-family relationship (range 34.6%-98.2%, p<0.001) and both the patient centredness of care Eliciting Concerns (median range 4.0-5.0, p<0.001) and Decision-Making (median range 2.3-4.5, p<0.001) scales. CONCLUSIONS: Four novel phenotypes of palliative care need were identified among ICU family members with distinct differences in the severity of needs and perceived quality of the clinician-family interaction. Knowledge of need class may help to inform the development of more person-centred models of ICU-based palliative care.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

BMJ Support Palliat Care

DOI

EISSN

2045-4368

Publication Date

September 27, 2022

Location

England

Related Subject Headings

  • 4205 Nursing
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
  • 1110 Nursing
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cox, C. E., Olsen, M. K., Parish, A., Gu, J., Ashana, D. C., Pratt, E. H., … Docherty, S. L. (2022). Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study. BMJ Support Palliat Care. https://doi.org/10.1136/spcare-2022-003622
Cox, Christopher E., Maren K. Olsen, Alice Parish, Jessie Gu, Deepshikha Charan Ashana, Elias H. Pratt, Krista Haines, et al. “Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study.BMJ Support Palliat Care, September 27, 2022. https://doi.org/10.1136/spcare-2022-003622.
Cox CE, Olsen MK, Parish A, Gu J, Ashana DC, Pratt EH, et al. Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study. BMJ Support Palliat Care. 2022 Sep 27;
Cox, Christopher E., et al. “Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study.BMJ Support Palliat Care, Sept. 2022. Pubmed, doi:10.1136/spcare-2022-003622.
Cox CE, Olsen MK, Parish A, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, Casarett DJ, Al-Hegelan MS, Naglee C, Katz JN, O’Keefe YA, Harrison RW, Riley IL, Bermejo S, Dempsey K, Wolery S, Jaggers J, Johnson KS, Docherty SL. Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study. BMJ Support Palliat Care. 2022 Sep 27;

Published In

BMJ Support Palliat Care

DOI

EISSN

2045-4368

Publication Date

September 27, 2022

Location

England

Related Subject Headings

  • 4205 Nursing
  • 4203 Health services and systems
  • 1117 Public Health and Health Services
  • 1110 Nursing