Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients

Burelli, Gabrielle; Berthelier, Chloé; Vanacker, Hélène; Descaillot, Léonard; Philippon-Jouve, Bénédicte; Fabré, Xavier; Kaaki, Mahmoud; Chakarian, Jean-Charles; Domine, Alexandre; Beuret, Pascal

doi:10.1016/j.accpm.2017.05.006

Cited by 5 publications

(9 citation statements)

References 19 publications

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“…The template we designed to create daily summaries may not be applicable to other ICU settings. However, the most common ICU problems we identified were similar to those described by other investigators (18). In addition, the process we used to develop summaries could be replicated in ICUs that care for a different patient population.…”

Section: Discussionsupporting

confidence: 86%

“…In this study, the transformation process from daily ICU notes to written summaries involved defining medical terminology, interpreting the results of tests or procedures, summarizing the recommendations of consulting services, and explaining the thought process of the ICU clinicians. “OpenNotes” is an initiative whereby clinicians are encouraged to share clinical notes directly with patients (18). The results of our study support the notion that families of ICU patients would appreciate reading notes written by ICU clinicians if the notes are understandable.…”

Section: Discussionmentioning

confidence: 99%

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Written Care Summaries Facilitate Communication Between Families and Providers of ICU Patients: A Pilot Study

Bulger

Quinn

Glover

et al. 2021

Critical Care Explorations

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OBJECTIVES: ICU providers may invite families to participate in daily rounds to inform them of the patient’s condition and to support their emotional well-being. Daily written summaries of care may provide complementary benefits. DESIGN: Qualitative interviews with surrogates of ICU patients who received daily written summaries of care. SETTING: Single, urban academic medical center. PATIENTS/SUBJECTS: A convenience sample of 30 surrogates of nondecisional, medical ICU patients. INTERVENTIONS: Daily written summaries detailed each of the patient’s main ICU problems, the presumed causes of each of the problems, and the medical team’s plan to address each of the problems for each ICU day. MEASUREMENTS AND MAIN RESULTS: There were four ways that written summaries affected the participant’s experience: 1) providing clarity to participants regarding the patient’s condition, 2) facilitating participant understanding of the patient’s clinical course, 3) facilitating communication between participants and medical providers, and 4) facilitating communication between participants and other family members. Overarching themes were that summaries were understandable, had appropriate level of detail, and added value to the ICU experience. CONCLUSIONS: In this pilot study, family members had positive impressions of receiving daily written summaries of care. Further study is needed to determine the extent to which written communication may affect family and patient outcomes.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Written Care Summaries Facilitate Communication Between Families and Providers of ICU Patients: A Pilot Study

Bulger

Quinn

Glover

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

“…Numerous studies have shown a discordance of 50% or more in prognosis estimates between physicians and family members of critically ill patients. [6][7][8][9][10] Physicians' estimates of prognosis are more accurate than relatives' estimates regarding hospital survival. 11 This implies that relatives often have a wrong assessment of patients' prognosis.…”

Section: Family Members In the Icu Commonly Have Inaccurate Expectations Of Patient's Prognosismentioning

confidence: 99%

“…Therefore we developed a visual support tool, dedicated to family members, available in the room of the patient and depicting day by day the evolution of his condition. 9 Every day in the morning physicians assessed global, hemodynamic, respiratory, renal and neurological conditions of each patient and put a point on the 5 related curves of the visual aid (Figure 1). The addition of new points allowed to visualize curves illustrating the clinical state of the patient during his intensive care unit stay.…”

Section: Graphicalmentioning

confidence: 99%

“…A controlled study showed that adding the visual support to classic oral information allowed the patient's family to have an estimate of the prognosis more concordant with the estimate of the physician. 9 It seems that the support may better align the perception of patient's prognosis by relatives to the real evolution of the condition of the patient, partly avoiding unrealistic optimism if an unfavorable trend was to occur. The support may act as a reference for family members, when faced with the dispersion of the information delivered by numerous caregivers, physicians or nurses.…”

Section: Graphicalmentioning

confidence: 99%

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Communication with relatives on prognosis of critically ill patients

Beuret¹,

Veislinger

2022

MRAJ

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Most patients admitted to the intensive care unit are unable to participate in decisions relating to their care. Therefore, physicians have to inform relatives on the condition of the patient, his evolution and the estimated prognosis. Numerous studies have shown that relatives commonly have inaccurate expectations of the patient’s prognosis, due to either misunderstanding of oral information by the physicians and/or overly optimistic beliefs. This may lead to undue prolongation of an ICU stay in the case of a poor prognosis. Several methods have been proposed in order to align relatives with the estimation of the patient’s prognosis by the physicians. The use of visual tools, added to oral information seems beneficial. Moreover, communication with relatives on the prognosis has to convey support and empathy.

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Impact of a Visual Support Dedicated to Prognosis on Symptoms of Stress of ICU Family Members: A Before-and-After Implementation Study

Veislinger-Burelli¹,

Vincent²,

Mallard

et al. 2021

Critical Care Explorations

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OBJECTIVES: Family members commonly have inaccurate expectations of patient’s prognosis in ICU. Adding to classic oral information, a visual support, depicting day by day the evolution of the condition of the patient, improves the concordance in prognosis estimate between physicians and family members. The objective of this study was to evaluate the impact of this tool on symptoms of anxiety/depression of family members. DESIGN: Bicenter prospective before-and-after study. SETTING: A nonacademic and a university hospital. SUBJECTS: Relatives of consecutive patients admitted in the two ICUs. INTERVENTIONS: In the period “before,” family members received classic oral information, and in the period “after,” they could consult the visual support in the patient’s room. The primary endpoint was the Hospital Anxiety and Depression Scale score of relatives at day 5. Secondary outcomes were the prevalence of symptoms of anxiety (Hospital Anxiety and Depression Scale anxiety subscale score > 7) and depression (Hospital Anxiety and Depression Scale depression subscale score > 7) at day 5 and Hospital Anxiety and Depression Scale score at day 90. MEASUREMENTS AND MAIN RESULTS: A total of 140 patients and their referent family members were included (77 in period before and 63 after). Characteristics of patients of the two groups were similar regarding age, reason for admission, Simplified Acute Physiology Score II at admission, and Sequential Organ Failure Assessment score at day 5. At day 5, median Hospital Anxiety and Depression Scale score was 17 (9–25) before and 15 (10–22) after the implementation of the visual support (p = 0.43). The prevalence of symptoms of anxiety and depression was similar in the two groups (66.2% and 49.4% before and 68.3% and 36.5% after [not significant], respectively). At day 90, median Hospital Anxiety and Depression Scale score was 11 before (7–16) and 9 (5–16) after the implementation of the tool (p = 0.38). CONCLUSIONS: In this study, the use of a visual support tool dedicated to prognosis did not modify the level of stress of family members.

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Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients

Cited by 5 publications

References 19 publications

Written Care Summaries Facilitate Communication Between Families and Providers of ICU Patients: A Pilot Study

Written Care Summaries Facilitate Communication Between Families and Providers of ICU Patients: A Pilot Study

Communication with relatives on prognosis of critically ill patients

Impact of a Visual Support Dedicated to Prognosis on Symptoms of Stress of ICU Family Members: A Before-and-After Implementation Study

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