Monday, September 5, 2005
July's Chest has a piece looking at the quality of dying in the ICU (it's based on a retrospective survey of bereaved family members). 10 years after SUPPORT it appears that symptoms/pain are still very poorly controlled in the ICU for the dying. Besides pain control, what the families felt was most related to the quality of death were: feeling at peace with dying, keeping one's dignity and self-respect, and having control over what was going on around the dying patient. The last of those seems completely anathema to the whole ICU experience and structure; what would be interesting would be to explore what really it means to patients and families to have control over what was going on around the patient in the ICU. My guess is that it would be quite modest & achievable, especially for those that everyone accepts are dying (visiting; noise in the room; some control of who enters into the room; religious & cultural rituals, etc.).