Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction*

Abstract

This study suggests that allowing family members more opportunity to speak during conferences may improve family satisfaction. Future studies should assess the effect of interventions to increase listening by critical care clinicians on the quality of communication and the family experience.

Analysis of enacted difficult conversations in neonatal intensive care

“…[17][18][19][20] In our study, practitioners verbally dominated family meetings talking substantially more than actorfamily members (70 vs 30%). Our results using realistic enactments are strikingly consistent with the findings of McDonagh et al, 21 who reported that in actual end-of-life conferences in adult intensive care units (ICUs), clinicians spoke 71% and family members 29% of the time. Greater opportunity for family members to speak in ICU family meetings has been positively associated with family satisfaction and less conflict with staff.…”

“…Greater opportunity for family members to speak in ICU family meetings has been positively associated with family satisfaction and less conflict with staff. 21 The unequal proportion of family-to-practitioner speech observed in our study highlights an area of clinical practice worthy of further exploration and improvement. Analysis of the content of the conversations revealed that practitioners, especially physicians, devoted most of their statements to providing biomedical information.…”

“…That said, practitioners rated the scenario as very realistic and the data generated from the enacted family meetings were strikingly similar to published accounts of actual family meetings. 21 Participants were aware of being videotaped within the program, which may have affected their performance; however, studies have demonstrated that the effect on performance is minimal. 32,33 Although RIAS allowed for a quantitative and comparable description of the communicative contribution of practitioners and family members, it did not capture potentially important aspects of communication such as non-verbal gestures and moments of silence.…”

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

“…37,40 Others have since demonstrated that this involves listening more and speaking less. 41 while ensuring management plans are shared with all members of the multidisciplinary team. 42 The multidisciplinary team approach has been shown to benefit patients with acute brain injury, both acutely 43 and during rehabilitation.…”

Life after death in the ICU: detecting family-centered outcomes remains difficult

“…Among the many potential contributors to these adverse bereavement outcomes are the circumstances surrounding and processes of limiting life support. This hypothesis is supported by evidence that ICU deaths are commonly preceded by decisions to withdraw life support [3], and evidence that both ICU processes of care [4,5] and behaviors of ICU clinicians [1,6] near the end of life can influence family members' post-ICU psychological outcomes. Thus, uncertainty regarding which approaches to withdrawing mechanical ventilation are least distressing for patients and families [7,8] represents an important area for rigorous investigation.…”