Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors

Studdert, David M.; Mello, Michelle M.; Burns, Jeffrey P.; Puopolo, Ann Louise; Galper, Benjamin Z.; Truog, Robert D.; Brennan, Troyen A.

doi:10.1007/s00134-003-1853-5

Cited by 193 publications

(110 citation statements)

References 26 publications

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“…This is important because prior research has shown that conflict among clinicians in the ICU about end-of-life care is common and harmful to patient care and clinician well-being. 35,[46][47][48] In addition, research from outside the ICU setting suggests that improved interdisciplinary collaboration has a high likelihood of improving quality of palliative care. 49,50,51 Finally, clinicians' ratings may lead to interventions that are more likely to succeed in improving care because they are directed to resolving problems that are recognized and endorsed by clinicians.…”

Section: Discussionmentioning

confidence: 99%

Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit

Engelberg

Curtis³

et al. 2010

D103. Ethics and End-of-Life in the Icu

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Objective-There are numerous challenges to successfully integrating palliative care in the ICU. Our primary goal was to describe and compare the quality of palliative care delivered in an ICU as rated by physicians and nurses working in that ICU.Design-Multi-site study using self-report questionnaires. Setting-Thirteen hospitals throughout the United States.Participants-Convenience sample of 188 physicians working in critical care (attending physicians, critical care fellows, resident physicians) and 289 critical care nurses.Measurements-Clinicians provided overall ratings of the care delivered by either nurses or physicians in their ICU for each of seven domains of ICU palliative care using a 0-10 scale (0 indicating the worst possible and 10 indicating the best possible care). Analyses included descriptive statistics to characterize measurement characteristics of the 10 items, paired Wilcoxon tests comparing item ratings for the domain of symptom management with all other item ratings, and regression analyses assessing differences in ratings within and between clinical disciplines. We used p<0.001 to denote statistical significance to address multiple comparisons.Main Results-The ten items demonstrated good content validity with few missing responses, ceiling or floor effects. Items receiving the lowest ratings assessed spiritual support for families, emotional support for ICU clinicians, and palliative-care education for ICU clinicians. All but two items were rated significantly lower than the item assessing symptom management (p<0.001). NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2012 May 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptNurses rated nursing care significantly higher (p<0.001) than physicians rated physician care in five domains. In addition, while nurses and physicians gave comparable ratings to palliative care delivered by nurses, nurses' and physicians' ratings of physician care were significantly different, with nurse ratings of this care lower than physician ratings on all but one domain.Conclusion-Our study supports the content validity of the 10 overall rating items and supports the need for improvement in several aspects of palliative care including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the ICU. Further, our findings provide some preliminary support for surveying ICU clinicians as one way to assess the quality of palliative care in the ICU.

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Section: Discussionmentioning

confidence: 99%

Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit

Engelberg

Curtis³

et al. 2010

D103. Ethics and End-of-Life in the Icu

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“…5,9 Sources of ethical conflict include poor communication, competing values and interests, divergent goals, and disruptive behavior. [9][10][11] Whether they occur between providers and patients' families or among health care teams themselves, ethical conflicts in intensive care units (ICUs) are prevalent. 2,5,[12][13][14][15] In the Conflicus Study, 71.6% of 7498 ICU nurses and physicians in 24 countries reported a perceived ethical conflict in the week before the survey.…”

Section: Introductionmentioning

confidence: 99%

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pavlish¹,

Hellyer²,

Brown-Saltzman³

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the impact of ethical conflict in the intensive care unit (ICU) for patients, families, and health care workers. 2. Describe risk factors and early warning signs of potential ethical conflicts with ICU patients. 3. Explain key results of ethical risk factor screening for critical care nurses. Results Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium-and low-risk situations. Certain risk factors featured prominently in high-risk situations. Conclusions A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

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“…They are confronted with a complex technical environment and frequent changes in staff, and they have a multitude of expectations. The critical care environment may place a prolonged burden on patients [8,9] and their next of kin [7,[10][11][12]. Families are not just visitors in the ICU; they experience the process of care along with their loved ones [13,14].…”

Section: Introductionmentioning

confidence: 99%

Family satisfaction in the intensive care unit: what makes the difference?

et al. 2009

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Purpose: To assess family satisfaction in the ICU and to identify parameters for improvement. Methods: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. Results: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78 ± 14 (mean ± SD) for overall satisfaction, 79 ± 14 for care and 77 ± 15 for information/decisionmaking. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performanceimportance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. Conclusions: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvement.

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Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors

Abstract: Conflict is common in the care of patients with prolonged stays in the ICU. However, efforts to improve the quality of care for critically ill patients that focus on team-family disagreements over life-sustaining treatment miss significant discord in a variety of other areas.

Cited by 193 publications

References 26 publications

Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit

Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Family satisfaction in the intensive care unit: what makes the difference?

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