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RATIONALE AND OBJECTIVES: All grants and manuscripts bearing the Canadian Critical Care Trials Group name are submitted for internal peer review before submission. The authors sought to formally evaluate authors’ and reviewers’ perceptions of this process.METHODS: The authors developed, tested and administered two electronic nine-item questionnaires for authors and two electronic 13-item questionnaires for reviewers. Likert scale, multiple choice and free-text responses were used.RESULTS: Twenty-one of 29 (72%) grant authors and 16 of 22 (73%) manuscript authors responded. Most author respondents were somewhat or very satisfied with the turnaround time, quality of the review and the review process. Two-thirds of grant (13 of 20 [65%]) and manuscript authors (11 of 16 [69%]) reported one or more successful submissions after review. Changes made to grants based on reviews were predominantly editorial and involved the background, rationale, significance/relevance and the methods/protocol sections. Twenty-one of 47 (45%) grant reviewers and 32 of 44 (73%) manuscript reviewers responded. Most reviewer respondents reported a good to excellent overall impression of the review process, good fit between their expertise and interests and the grants reviewed, and ample time to review. Although most respondents agreed with the current nonblinded review process, more grant than manuscript reviewers preferred a structured review format.CONCLUSIONS: The authors report a highly favourable evaluation of an existing internal review process. The present evaluation has assisted in understanding and improving the current internal review process.

BACKGROUND: Understanding patients’ needs and perspectives is fundamental to improving end-of-life (EOL) care. However, little is known of what quality care means to patients who have advanced lung disease.OBJECTIVES: To describe ratings of importance and satisfaction with elements of EOL care, informational needs, decision-making preferences, obstacles to a preferred location of death, clinical outcomes, and health care use before and during an index hospital admission for patients who have advanced chronic obstructive pulmonary disease (COPD).METHODS: A questionnaire with regard to quality EOL care was administered to patients older than 55 years of age who had advanced medical disease in five Canadian teaching hospitals.RESULTS: For 118 hospitalized patients who had advanced COPD, the following items were rated as extremely important for EOL care: not being kept alive on life support when there is little hope for meaningful recovery (54.9% of respondents), symptom relief (46.6%), provision of care and health services after discharge (40.0%), trust and confidence in physicians (39.7%), and not being a burden on caregivers (39.6%). Compared with patients who had metastatic cancer, patients with COPD had lower (P<0.05) satisfaction with care, interest in information about prognosis, cardiopulmonary resuscitation or mechanical ventilation, and referral rates to palliative care, whereas use of acute care services was higher (P<0.05) for patients who had advanced COPD.CONCLUSION: Canadian patients who have advanced COPD identify several priorities for improving care. Avoidance of prolonged or unwanted life support requires more effective communication, decision making and goal setting. Patients also deserve better symptom control and postdischarge strategies to minimize perceived burdens on caregivers, emergency room visits and hospital admissions.