[Documentation of changes in goals of care in intensive care units - retrospective medical record analysis of deceased patients].

BACKGROUND

End-of-life intensive care interventions correlate with a reduced quality of life of dying patients. Reassessment of clinical indication and patients' preferences, along with potential changes in goals of care, is needed. Changes in goals of care are not sufficiently documented in some instances.

OBJECTIVES

Analysis of terms used to document changes in goals of care in medical records and documented therapy adjustment.

MATERIALS AND

METHODS

Retrospective analysis of n = 160 records of deceased patients from four intensive care units (n = 40 per unit) of one university hospital. Descriptive and qualitative content analysis were performed using Excel (Microsoft Corporation, Redmond, Washington, USA) and MAXQDA 24 (VERBI Software GmbH, Berlin, Germany).

RESULTS

Documentation of changes in goals of care were found in 78% (125/160) of the records. Terms describing changes could be categorized into eleven groups: 'Palliative' (n = 29), 'Treatment withdrawal' (n = 19), 'Best supportive care/symptom control' (n = 18), 'Do not escalate' (n = 13), 'Limitation of therapy' (n = 11), 'Changes in goals of care' (n = 10), 'Do not resuscitate/do not intubate' (n = 10), 'Freeze' (n = 7), 'Specific interventions' (n = 3), 'Mixed terms of changes in goals of care' (n = 3) and 'Others' (n = 2). In the sample, descriptive differences were observed in the frequency of terms depending on ward and patients' age. Therapy adjustments varied in some cases between the terms. For example, mechanical ventilation was discontinued most frequently in the group 'Palliative', at 71% (17/24).

CONCLUSION

Recommended terms to describe goals of care were used inconsistently. Changes in measures and the terms showed only partially similar patterns. A uniformly defined understanding of the team and a structured application of the terms could support the interdisciplinary implementation of changes in goals of care.