(112) Death, Dying, and Reflection Rounds (DDRR): Facilitating End-of-Life Discussions Among ICU Residents

Sunday, February 23, 2025

9:45am – 10:45am Eastern Time

Location: Connections Central - RST 02

First Author(s)

Eva Ma, MD

Loma Linda University
Grand Terrace, California, USA

Co-Author(s)

AM

Anton Manyak, MD

Pulmonary/Critical Care Physician
Loma Linda University Medical Center, United States
CB

Christina Bohr, DO

Pulmonary/Critical Care Fellow
Loma Linda University Medical Center, United States
SG

Sahib Grewal, MD

Pulmonary/Critical Care Fellow
Loma Linda University Medical Center, United States
NS

Norman L. Specht, MD

Assistant Professor of Medicine and Cardiopulmonary Sciences
Loma Linda University Medical Center, United States
AM

Aarti C. Mittal, MD

Pulmonary/Critical Care Physician
Riverside University Health System, United States
BN

Bryant H. Nguyen, MD

Professor of Medicine
Loma Linda University Medical Center, United States

Introduction: End-of-life and goals-of-care discussions (EoL/GoCD) are crucial components of patient care in the intensive care unit (ICU). However, residents often receive limited education on this topic and feel unprepared to lead these challenging conversations. To address this gap, Death, Dying, and Reflection Rounds (DDRR) were introduced in our medical ICU. The objective was to enhance residents' comfort with EoL/GoCD while providing a structured environment to reflect on their experiences and emotions involved in caring for critically ill patients. This study evaluates the impact of DDRR as an educational tool for EoL/GoCD among ICU residents.

Methods: Bi-weekly DDRR were implemented in the medical ICU. Data from pre- and post-round surveys obtained from resident participants were analyzed using descriptive statistics and paired t-tests. The surveys evaluated residents' comfort and confidence in EoL discussions, the perceived educational value of DDRR, and their likelihood of recommending the training to peers based on a Likert scale of 1 to 5.

Results: A total of 65 paired pre and post-intervention surveys were collected, primarily from PGY-1 trainees (55%). Residents reported increased time and opportunity for processing patient deaths (3.1±0.9 pre-DDRR vs. 3.6±0.9 post-DDRR, p = 0.00005), improved adequacy of end-of-life education (3.0±0.9 vs. 3.7±0.8, p < 0.00001), and enhanced comfort with goals-of-care discussions (3.4±0.9 vs. 3.7±0.9, p = 0.01). These improvements were inversely correlated with PGY level and were not statistically significant for PGY-3 respondents. Following DDRR, 84% of residents felt confident in leading EoL/GoCD, and 97% recommended DDRR to their peers.

Conclusions: DDRR significantly enhanced residents' comfort and confidence in conducting EoL discussions in the medical ICU. These sessions also provided a supportive environment for processing the emotional challenges associated with caring for dying patients. The majority of residents found DDRR to be a valuable educational intervention and would recommend them to colleagues. Based on our results, we recommend incorporating DDRR into the ICU curriculum for medical training.