Family satisfaction with the end-of-life discussions and resuscitation orders for patients with severe COVID-19: a multicenter study in Saudi Arabia.

backgroundDespite the significant mortality, data on end-of-life (EoL) discussions during COVID-19 pandemic are scarce. Health care providers had to cope with significant challenges, particularly overcoming barriers to effective communication with patients and their families, and lack of information on therapy and prognosis. This study was undertaken to assess the satisfaction of close family members (CFMs) with EoL discussions for patients hospitalized with severe COVID-19 infection.

methodsThe study was conducted in five major hospitals in Saudi Arabia. Medical charts of consecutive patients who died from COVID-19 complications were retrospectively reviewed. Demographic and clinical data were collected, and communication with close family members (CFMs) about clinical decisions were evaluated. A follow-up telephone interview was conducted using a validated Arabic questionnaire to evaluate satisfaction of CFMs with the EoL discussions prior death.

resultsEoL discussions were documented in less than half (67, 49.28%) and were often delayed (the median time 19.75 days [range 1-119] after admission. However, in the interviews of the CFMs, 109 of 136 (80.15%) acknowledged that physicians had shared with them information regarding the medical condition of the patient. Most of these discussions were conducted with the CFMs rather than the patients. Do Not Attempt Resuscitation orders were implemented in half of the patients, and most CFMs (70%) felt they were appropriate. Satisfaction levels for physicians, were as follows: 61.68% for the adequacy of information provided, 60.00% for time spent, and 61.49% for empathy from physicians. A strong correlation existed between the time spent and both the adequacy of information (rs = 0.89, p < 0.001) and empathy (rs = 0.82, p < 0.001). As for nursing performance, satisfaction was 47.83% for information, 48.06% for time, and 55.81% for empathy. Physicians' scores were significantly higher than nurses on information sharing (P = 0.022) and time spent (P = 0.05), but there was not significant difference with regards to empathy.

conclusionDespite the challenges associated with the pandemic, there is room for improvement in EoL discussions, particularly the early introduction of personalized goal-oriented care plans. Defining roles and fostering interdisciplinary collaboration between healthcare professionals may enhance satisfaction of patients and their families.