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

OUTCOMES: 1. Learn the components of the Bereaved Family Survey and what it measures 2. Describe whether there were changes in end-of-life care ratings after the pandemic started IMPORTANCE: Given 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. RESULTS: Of 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. IMPACT: Our study shows that the quality of EOL care can be preserved during periods of stress such as the COVID-19 pandemic.