Table 1 Delphi ratings for the advocated quality indicators
|  |  | Round 3 (n = 16) |  | Round 5 (n = 16) |  | ||||
|---|---|---|---|---|---|---|---|---|---|
| Â | Â | Validity | Feasibility | Validity | Feasibility | ||||
Indicators | Median | Agree (%)* | Median | Agree (%)* | Median | Agree (%)* | Median | Agree (%)* | |
Process | Â | Â | Â | Â | Â | Â | Â | Â | Â |
1 | Regular pain assessment | 8 | 81.3 | 7.5 | 75.0 | 8 | 87.5 | 8 | 87.5 |
2 | Appropriate pain management | 8 | 75.0 | 7 | 62.5 | 8 | 93.8 | 7 | 75.0 |
3 | Reassessment of pain after treatment and/or management | 8 | 81.3 | 6.5 | 50.0 | 8 | 87.5 | 8 | 81.3 |
4 | Regular delirium assessment | 8 | 75.0 | 8 | 81.3 | 8 | 87.5 | 8 | 87.5 |
5 | Assessment of the patient's psychological distress | 7 | 50.0 | 5 | 31.3 | 7 | 56.3 | 6 | 43.8 |
6 | Assessment of public social support needs | 8 | 81.3 | 7 | 68.8 | 7.5 | 93.8 | 7 | 81.3 |
7 | Assessment of the patient's spiritual and cultural practices | 7 | 56.3 | 5 | 25.0 | 7 | 68.8 | 5 | 37.5 |
8 | Identification of the patient's advance directive and ACP for treatment | 8 | 75.0 | 6 | 43.8 | 8 | 93.8 | 7 | 68.8 |
9 | Conducting an interdisciplinary family conference on palliative care | 7.5 | 81.3 | 7 | 68.8 | 8 | 93.8 | 8 | 81.3 |
10 | Transmission of key information regarding palliative care following ICU transfer | 8 | 81.3 | 7 | 56.3 | 8 | 93.8 | 7 | 62.5 |
11 | Assessments of psychological distress of family members | 8 | 87.5 | 7 | 68.8 | 8 | 93.8 | 7 | 81.3 |
12 | Documentation of the medical process regarding end-of-life decisions | 8 | 81.3 | 7 | 56.3 | 8 | 87.5 | 7.5 | 75.0 |
13 | Modification of medical care for it to be in concordance with the goals of care for patients at the end of life | 8 | 81.3 | 6 | 37.5 | 8 | 93.8 | 7 | 68.8 |
Outcome | Â | Â | Â | Â | Â | Â | Â | Â | Â |
14 | Patient pain-free in the last 24Â h of life | 8 | 75.0 | 8 | 75.0 | 8 | 93.8 | 7.5 | 81.3 |
15 | Avoid performing CPR when the patient does not want | 8 | 68.8 | 8 | 75.0 | 8 | 87.5 | 8 | 81.3 |
Structure | Â | Â | Â | Â | Â | Â | Â | Â | Â |
16 | Use of standardized pain measurement scales | 9 | 100.0 | Â | Â | Â | Â | Â | Â |
17 | Use of standardized dyspnea measurement scales | 9 | 93.8 | Â | Â | Â | Â | Â | Â |
18 | Use of standardized thirst measurement scales | 8.5 | 100.0 | Â | Â | Â | Â | Â | Â |
19 | End-of-life-specific symptom management care protocols or order sets | 9 | 100.0 | Â | Â | Â | Â | Â | Â |
20 | Access to a palliative care team when pain and other physical symptoms are difficult to control | 9 | 100.0 | Â | Â | Â | Â | Â | Â |
21 | Access to a specialized psychiatric team in presence of delirium, anxiety, or other difficult-to-control psychiatric symptoms | 9 | 100.0 | Â | Â | Â | Â | Â | Â |
22 | A policy that allows for flexible visitation opportunities in accordance with the family's wishes | 9 | 93.8 | Â | Â | Â | Â | Â | Â |
23 | Rooms with privacy for discussions between healthcare providers and family members | 9 | 87.5 | Â | Â | Â | Â | Â | Â |
24 | The system to provide mental health care to patients and their families | 9 | 93.8 | Â | Â | Â | Â | Â | Â |
25 | Leaflet for family members, including information on orientation to the ICU environment and delirium care | 9 | 93.8 | Â | Â | Â | Â | Â | Â |
26 | A "Critical Care Mediator for Inpatients" is in place | 7 | 68.8 | Â | Â | 7 | 75.0 | Â | Â |
27 | Regular opportunities for ICU staff to reflect on their end-of-life care experiences to support their emotional well-being | 9 | 93.8 | Â | Â | Â | Â | Â | Â |
28 | Access to palliative care specialists and other professionals to discuss ethical issues related to treatment | 9 | 100.0 | Â | Â | Â | Â | Â | Â |