Bereaved Family Quality of Life Varies With Comorbid Psychological Distress and ICU-Care Quality

Fur-Hsing Wen; Holly G Prigerson; Li-Pang Chuang; Wen-Chi Chou; Tsung-Hui Hu; Chung-Chi Huang; Siew Tzuh Tang

doi:10.1016/j.jpainsymman.2024.11.023

Bereaved Family Quality of Life Varies With Comorbid Psychological Distress and ICU-Care Quality

J Pain Symptom Manage. 2024 Dec 6:S0885-3924(24)01190-4. doi: 10.1016/j.jpainsymman.2024.11.023. Online ahead of print.

Authors

Fur-Hsing Wen¹, Holly G Prigerson², Li-Pang Chuang³, Wen-Chi Chou⁴, Tsung-Hui Hu⁵, Chung-Chi Huang⁶, Siew Tzuh Tang⁷

Affiliations

¹ Department of International Business (F.H.W.), Soochow University, Taiwan, R.O.C.
² Department of Medicine (H.G.P.), Weill Cornell Medicine. New York City, New York, USA.
³ Department of Internal Medicine (L.P.C., C.C.H.), Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.
⁴ Division of Hematology-Oncology (W.C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.;; School of Medicine (W.C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.
⁵ Department of Internal Medicine (T.H.H.), Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C.
⁶ Department of Internal Medicine (L.P.C., C.C.H.), Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.; Department of Respiratory Therapy (C.C.H.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.
⁷ Division of Hematology-Oncology (W.C.C., S.T.T.), Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C.;; School of Nursing, Medical College (S.T.T.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C.. Electronic address: sttang@mail.cgu.edu.tw.

PMID: 39647607
DOI: 10.1016/j.jpainsymman.2024.11.023

Abstract

Context: Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes.

Objectives: Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss.

Methods: This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference.

Results: Physical and mental HRQOL were worse in the 3 more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the 3 poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators.

Conclusion: Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.

Keywords: Prolonged grief disorder, post-traumatic stress disorder, depression; family members, critical care; quality of life, bereavement.