Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Yiu MC(1), Chan CYC(1), Mak YM(1), Wong CYC(1), Yeung CH(1), Ng HM(1), Kwan YFE(1), Lo WPJ(1), Lee CH(1), Shum HP(1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Taking care of critically-ill patients in Intensive Care Unit (ICU) is challenging. When curative treatments become futile, some patients will spend their end-stages of lives in ICU [1]. Providing appropriate end-of-life care is difficult and often late. A structured spiritual-model which emphasizes on gracious communication will enhance family experience and satisfaction with end-of-life care [2].
Objectives :
This structured-model can also initiate a change in the culture of critical care, provide guardianship to nurses and help families to go through the grieving process.
Methodology :
The "Four-Paths and Five-Elements-四道五行" are incorporated into the care bundle to facilitate the integration of body, mind, spirit, enabling-wholeness, health, and a sense of self-connection to others. The Four Paths summarizes the dialogues of living and dying, guiding families to make their final farewells based on the four principles-of-life [3]. The Five Elements include interventions through visual, auditory, tactile, religious and cultural-means, as well as reflection on life.
A bereavement leaflet containing these elements was designed and distributed to families who met the inclusion criteria. The nurse guides family members to carry out the aforementioned interventions. The family satisfaction questionnaire is designed which modified from the Canadian Health Care Evaluation Project (CANHELP) [4]. The questionnaire would be given when patient succumbed to evaluate the quality of end-of-life service.
Result & Outcome :
A total of 28 cases were recruited from August 2022 to December 2023. Among these cases, 85.7% (n=24) of families received the bereavement leaflet, and 64.2% (n=18) of cases demonstrated the "Four-Paths and Five-Elements" approach during end-of-life care. However, there are still insufficient responses regarding end-of-life care satisfaction at the current stage. Three thank-you cards were received from the families. Nevertheless, a similar study conducted in Taiwan, focusing on demonstrating the "Four Paths" approach to families of terminally-ill patients, showed that families recognized the importance of the "Four Paths" and expressed willingness to accept the principles [5].
In concluded, this spiritual-model begins to be integrated into the patient's end-of-life care plan. Goals of care transit from curative to quality end-of-life care are emphasized. Further research is needed to explore the relationship between the "Four-Paths and Five-Elements" and family satisfaction with end-of-life care.
