Physician communication with families in the ICU: evidence-based strategies for improvement

Schaefer, Kristen G.; Block, Susan D.

doi:10.1097/mcc.0b013e328332f524

Cited by 73 publications

(58 citation statements)

References 59 publications

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“…When a family's prognostic understanding is not established before an emergency, they are less capable of fully grasping the impact of this event as an inflection point in the patient's health trajectory. 20,21,25,26 Additionally, the current medical system lacks the necessary infrastructure to support acute grief in the emergent setting. 27 Together, these factors make nonbeneficial treatments appealing in an attempt to gain control in an otherwise uncontrolled and distressing situation.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons, like other physicians, are generally poor at formulating and communicating prognosis. 20,21 Difficulty prognosticating may reflect inexperience with patients who opt for nonoperative care. Moreover, surgical risk calculators, such as National Surgical Quality Improvement Program (NSQIP), Surgical Apgar Score, and Physiological and Operative Severity for the enUmeration of Morbidity and Mortality (POSSOM), [22][23][24] are limited to predicting mortality and complications in the immediate postoperative period and do not include other meaningful outcomes such as longer-term mortality, function, or QOL.…”

Section: Discussionmentioning

confidence: 99%

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Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Cauley

Block

Koritsanszky

et al. 2016

Journal of Palliative Medicine

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Background: Clinical decisions for seriously ill older patients with surgical emergencies are highly complex. Measuring the benefits of burdensome treatments in this context is fraught with uncertainty. Little is known about how surgeons formulate treatment decisions to avoid nonbeneficial surgery, or engage in preoperative conversations about end-of-life (EOL) care. Objective: We sought to describe how surgeons approach such discussions, and to identify modifiable factors to reduce nonbeneficial surgery near the EOL. Design: Purposive and snowball sampling were used to recruit a national sample of emergency general surgeons. Semistructured interviews were conducted between February and May 2014. Measurements: Three independent coders performed qualitative coding using NVivo software (NVivo version 10.0, QSR International). Content analysis was used to identify factors important to surgical decision making and EOL communication.Results: Twenty-four surgeons were interviewed. Participants felt responsible for conducting EOL conversations with seriously ill older patients and their families before surgery to prevent nonbeneficial treatments. However, wide differences in prognostic estimates among surgeons, inadequate data about postoperative quality of life (QOL), patients and surrogates who were unprepared for EOL conversations, variation in perceptions about the role of palliative care, and time constraints are contributors to surgeons providing nonbeneficial operations. Surgeons reported performing operations they knew would not benefit the patient to give the family time to come to terms with the patient's demise. Conclusions: Emergency general surgeons feel responsible for having preoperative discussions about EOL care with seriously ill older patients to avoid nonbenefical surgery. However, surgeons identified multiple factors that undermine adequate communication and lead to nonbeneficial surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Cauley

Block

Koritsanszky

et al. 2016

Journal of Palliative Medicine

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“…Within the adult ICU literature, there is evidence that the empathic approach to family communication is associated with outcomes such as improved family satisfaction, although such evidence is lacking for the pediatric inpatient setting. 24 …”

Section: 31mentioning

confidence: 99%

“…ICU physicians who were observed giving prognostic information often failed to ask if families wanted to hear the information before giving it and, furthermore, did not check with families about their understanding of the information being shared. 24 Such simple strategies can combat miscommunication and confusion such as that caused by use of medical jargon or acronyms.…”

Section: Information Sharingmentioning

confidence: 99%

The Pediatric Inpatient Family Care Conference: A Proposed Structure Toward Shared Decision-Making

Fox

Brittan

Stille

2014

Hospital Pediatrics

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Over the past decade, there has been a steady increase in the medical complexity of patients on the pediatric inpatient service while at the same time, there are few data to show that families are satisfi ed with communication of complex issues. Family care conferences are defi ned as an opportunity outside of rounds to meet and discuss treatment decisions and options. They offer a potential pathway for psychosocial support and facilitated communication. The lack of consensus about the structure of these conferences impedes our ability to research patient, family, and provider outcomes related to communication. The goal of the present article was to describe a structure for family care conferences in the pediatric inpatient setting with a literature-based description of each phase of the conference. The theoretical framework for the structure is that patient and family engagement can improve communication and ultimately health care quality. This proposed model offers guidance to providers and researchers whose goal is to improve communication on the inpatient service. AUTHORS

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“…In order to optimize fetal outcome, there should be an interdisciplinary approach, including specialists in maternalfetal medicine, neonatology, genetics, pediatric surgery and pediatric cardiology. [83][84][85] Social work services may provide important support to the family before as well as after birth. Such team approach is the best way to address the important issues of where, when, and how the infant should be delivered, as well as the role of invasive fetal therapy.…”

Section: Invasive Prenatal Diagnosis For Cytogenetic Analysismentioning

confidence: 99%

Surgically Correctable Fetal Anomalies: Ultrasound Diagnosis and Management

Honemeyer¹,

Zaputović²,

Turudic³

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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A significant proportion of fetal anomalies are surgically correctable. Their accurate and reliable prenatal diagnosis is of great importance, and will have significant influence on both postnatal and postsurgical outcome. The influence of prenatal diagnosis of simple structural defects will interfere with organ development. In the light of recent achievements, traditional teratology has to be reexamined more critically.

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Physician communication with families in the ICU: evidence-based strategies for improvement

Abstract: Empathic communication, skilful discussion of prognosis, and effective shared decision-making are core elements of quality care in the ICU, represent basic competencies for the ICU physician, and should be emphasized in future educational and clinical interventions.

Cited by 73 publications

References 59 publications

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

Surgeons' Perspectives on Avoiding Nonbeneficial Treatments in Seriously Ill Older Patients with Surgical Emergencies: A Qualitative Study

The Pediatric Inpatient Family Care Conference: A Proposed Structure Toward Shared Decision-Making

Surgically Correctable Fetal Anomalies: Ultrasound Diagnosis and Management

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