Art of communication*

Roig, Cristian García

doi:10.1097/01.pcc.0000059426.98207.85

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…This finding is in accordance with the bioethics discipline in which the consensus regarding limitation or withdrawal of LST should be obtained between the families and the health team (31). For the decision-making process, information related to the diagnosis, the prognosis, the medical standards, the legality of the procedures, the norms of the institution, and society expectation is necessary (31)(32)(33)(34)(35)(36)(37)(38).…”

Section: Discussionsupporting

confidence: 57%

“…As demonstrated in other studies, when withdrawal or L-LST is proposed to a patient who is discriminated by public insurance, the parents immediately figure that the proposition is not based on the patient's benefit, but (probably) on financial or other interests (28). In addition, communication with some families in this large and multiracial country is sometimes very difficult as a result of the cultural and/or perception differences (31).…”

Section: Discussionmentioning

confidence: 96%

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Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil*

Kipper

Piva

García

et al. 2005

Pediatric Critical Care Medicine

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We observed that the modes of deaths in southern Brazilian PICUs changed over the last 13 yrs, with an increment in L-LST. However, this change was not uniform among the studied PICUs and did not reach the levels described in countries of the Northern Hemisphere. Family participation in the L-LST decision-making process has increased over time, but it is still far behind what is observed in other parts of the world.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 96%

Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil*

Kipper

Piva

García

et al. 2005

Pediatric Critical Care Medicine

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“…It is a common agreement that the family is the best representative of pediatric patients rights and should therefore be invited to participate in LSL decisions. 27 However, as verified in this study, the participation of family in these and in other decisions has been poorly encouraged and accepted (or respected) in our setting. Conversely, in northern hemisphere countries, promoting a good death is a priority, and the presence of family at the time of death is quite common.…”

Section: Discussionmentioning

confidence: 99%

“…It is common knowledge, however, that most Brazilian physicians find it difficult to deal with end-of-life issues. This presumably occurs due to their poor academic background, to scarce publications on the topic and also to the paternalistic medicine in southern hemisphere countries, 27,28 where decisions are taken in a unilateral fashion with the passive participation of family, which do not exercise their right to decide and, often disrespecting the patient autonomy. It is a common agreement that the family is the best representative of pediatric patients rights and should therefore be invited to participate in LSL decisions.…”

Section: Discussionmentioning

confidence: 99%

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Lago¹,

Piva²,

Kipper³

et al. 2005

J. Pediatr. (Rio J.)

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Objectives: To describe causes of death and factors involved in the decision-making process related to life support limitation at three university-affiliated pediatric intensive care units in the south of Brazil.Methods: A retrospective study was conducted, based on a review of the medical records of all deaths occurring during 2002 at three pediatric intensive care units in Porto Alegre. Three previously trained pediatric fellows from each service performed the study. Data were assessed relating to general case characteristics, causes of death (failed cardiopulmonary resuscitation, brain death, do-not-resuscitate orders, withholding or withdrawing lifesustaining treatment -the last three modes were classified as the life support limitation group), length of stay in hospital, end-of-life plans and the participation of patients families and Ethics Committees. The Student t test, Mann Whitney, chi-square, odds ratio and multivariate analyses were used for comparisons.Results: Close to 53.3% of fatal cases had received full cardiopulmonary resuscitation. The incidence of life support limitation was 36%, with statistical differences (p = 0.014) between the three hospitals (25 versus 54.3 and 45.5%, respectively). The most frequent form of life support limitation was a do-not-resuscitate order (70%). Life support limitation was associated with the presence of chronic disease (odds ratio = 8.2; 95%CI 3.2-21.3) and length stay in the pediatric intensive care unit (odds ratio = 4.4; 95%CI 1.6-11.8). The rate of involvement of families and Ethics Committees in the decision-making process was lesser than 10%.Conclusions: Cardiopulmonary resuscitation is offered more frequently than is observed in northern countries. In contrast, life support limitation is offered through do-not-resuscitate orders. These findings and the low participation of the families in the decision-making process reflect the difficulties to be overcome by those professionals who are responsible for handling critically ill children in southern Brazil.J Pediatr (Rio J). 2005;81(2):111-7: Death, ethics, pediatric intensive care, forgoing life support, do-notresuscitate orders.

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“…Low-quality or ineffective communication is frequently cited as a major contributor to futility disputes in critical care settings, and a number of opinions and recommendations for improved communication now exist in the literature. 2,3,6,8,9,17,[19][20][21] Some literature suggests that family members value communication at least as much and perhaps more than the clinical skill of their loved ones' providers. 19 The Critical Care End-of-Life Peer Workgroup publication identifies effective communication as 1 of the 7 domains key to end-of-life care.…”

Section: Communication In Futility Disputesmentioning

confidence: 99%

Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building

Leland

Torke

Wocial

et al. 2016

J Intensive Care Med

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Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication. Finally, we propose a futility dispute navigation model built upon improved communication through trust building.

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Art of communication*

Cited by 4 publications

References 12 publications

Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil*

Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil*

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building

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