Family Members' Feedback on the "Quality of Death" of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis

Kazuaki Naya; Hideaki Sakuramoto; Gen Aikawa; Akira Ouchi; Shun Yoshihara; Yuma Ota; Saiko Okamoto; Ayako Fukushima; Haruyoshi Hirashima

doi:10.7759/cureus.58344

Family Members' Feedback on the "Quality of Death" of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis

Cureus. 2024 Apr 15;16(4):e58344. doi: 10.7759/cureus.58344. eCollection 2024 Apr.

Authors

Kazuaki Naya¹, Hideaki Sakuramoto², Gen Aikawa³, Akira Ouchi³, Shun Yoshihara², Yuma Ota⁴, Saiko Okamoto⁵, Ayako Fukushima², Haruyoshi Hirashima⁶

Affiliations

¹ Department of Adult Nursing, Tokyo Healthcare University Wakayama Faculty of Nursing, Wakayama, JPN.
² Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JPN.
³ Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, JPN.
⁴ Department of Fundamental Nursing, Tokyo Healthcare University Faculty of Healthcare, Shinagawa, JPN.
⁵ Department of Nursing, Hitachi General Hospital, Hitachi, JPN.
⁶ Advanced Critical Care Center, Kurume University Hospital, Kurume, JPN.

Abstract

Intensive care units (ICUs) are designed for critically ill patients who often experience high mortality rates owing to the severity of their conditions. Although the primary goal is patient recovery, it is crucial to understand the quality of death in the ICU setting. Nevertheless, there is a notable lack of systematic reviews on measured death quality and its associated factors. This study aims to conduct a quantitative synthesis of evidence regarding the quality of death in the ICU and offers a comprehensive overview of the factors influencing this quality, including its relationship with the post-intensive care syndrome-family (PICS-F). A thorough search without any language restrictions across MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi databases identified relevant studies published until September 2023. We aggregated the results regarding the quality of death care for patients who died in the ICU across each measurement tool and calculated the point estimates and 95% confidence intervals. The quantitative synthesis encompassed 19 studies, wherein the Quality of Dying and Death-single item (QODD-1) was reported in 13 instances (Point estimate: 7.0, 95% CI: 6.93-7.06). Patient demographic data, including age and gender, as well as the presence or absence of invasive procedures, such as life support devices and cardiopulmonary resuscitation, along with the management of pain and physical symptoms, were found to be associated with a high quality of death. Only one study reported an association between quality of death and PICS-F scores; however, no significant association was identified. The QODD-1 scale emerged as a frequently referenced and valuable metric for evaluating the quality of death in the ICU, and factors associated with the quality of ICU death were identified. However, research gaps persist, particularly regarding the variations in the quality of ICU deaths based on cultural backgrounds and healthcare systems. This review contributes to a better understanding of the quality of death in the ICU and emphasises the need for comprehensive research in this critical healthcare domain.

Keywords: bereaved family; death quality; intensive care unit (icu); quality of dying and death; systematic review.

Publication types

Review

Grants and funding

Funding for this study was provided by unrestricted grants from NEW NURSING, Inc. (grant number: N/A). The funding source had no role in the design, practice, or analysis of this study.