Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

Abstract

Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.

The specialty of surgical critical care: A white paper from the American Association for the Surgery of Trauma Critical Care Committee

“…83 However, evidence for communication practices in SCC populations has been mostly adapted from nonsurgical ICUs, where older patients and those with preexisting illnesses have often prompted prior EOL discussions among patients and families. 24 The necessity of context-specific communication skills is particularly striking in SCC due to the concept of "sudden advanced illness" (SAI), which is characterized by unforeseen, acute, and devastating illness/injury that strikes with higher frequency in younger and healthier patients. 84 Having SAI is often associated with uncertain prognosis, in contrast to older patients with sequelae of chronic medical illnesses where disease trajectories are more predictable.…”

“…These difficult and complex conversations necessarily include bidirectional communication from the care team, as well as listening to the concerns of the patient, family, or surrogate. 24 As patients improve and are transferred out of the ICU the transition to units where nurse staffing is less intensive than in the ICU can be difficult for patients and families. Over the course of days, weeks, or even months in the ICU, they have become familiar with the personnel and routines, so the unavoidable change can be challenging.…”

“…Integral to this is maintaining communication with patients, as well as families 23 regarding current status, potential complications, need for therapies as well as the family's understanding of the patient's wishes regarding medical interventions. These difficult and complex conversations necessarily include bidirectional communication from the care team, as well as listening to the concerns of the patient, family, or surrogate 24 …”

“…Research on goals of care has been identified as a critical deficiency in the SCC literature 83 . However, evidence for communication practices in SCC populations has been mostly adapted from nonsurgical ICUs, where older patients and those with preexisting illnesses have often prompted prior EOL discussions among patients and families 24 …”

“…Also, SAI is marked by a role reversal of decision makers, often with parents, spouses, or siblings acting as surrogates instead of the usual pattern of adult children making decisions for elderly parents 84 . Trauma in particular often results in the “near instantaneous transition between normal life and high-intensity medical interventions.” 24 Trauma patients may also present with additional challenges including substance abuse, mental illness, and insubstantial social support systems. The devastating, sudden impact of trauma on families has been termed “the 2nd trauma” and has prompted specific training and education to address communication practices in this setting 85,86 .…”