Missed Opportunities during Family Conferences about End-of-Life Care in the Intensive Care Unit

• Published in: American journal of respiratory and critical care medicine 2005-04, Vol.171 (8), p.844-849
• Main Authors: Curtis, J. Randall, Engelberg, Ruth A, Wenrich, Marjorie D, Shannon, Sarah E, Treece, Patsy D, Rubenfeld, Gordon D
• Format: Article
• Language: English
• Subjects: Adult; Advance Directives - ethics; Advance Directives - psychology; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Communication; Critical care; Decision making; Emotions; Empathy; Ethics, Medical; Female; Grounded theory; Humans; Intensive care; Intensive care medicine; Intensive Care Units - ethics; Investigative techniques, diagnostic techniques (general aspects); Legal Guardians - psychology; Life Support Care - ethics; Life Support Care - psychology; Male; Medical sciences; Middle Aged; Palliative care; Palliative Care - ethics; Palliative Care - psychology; Patient Care Team - ethics; Patients; Physician's Role - psychology; Physicians; Professional-Family Relations - ethics; Qualitative research; Quality Assurance, Health Care - ethics; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Terminal Care - ethics; Terminal Care - psychology; Withholding Treatment - ethics
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200409-1267OC

Improved communication with family members of critically ill patients can decrease the prolongation of dying in the intensive care unit (ICU), but few data exist to guide the conduct of this communication. Our objective was to identify missed opportunities for physicians to provide support for or information to family during family conferences. We identified ICU family conferences in four hospitals that included discussions about withdrawing life support or delivery of bad news. Fifty-one conferences were audiotaped, including 214 family members. Thirty-six physicians led the conferences and some physicians led more than one. We used qualitative methods to identify and categorize missed opportunities, defined as an occurrence when the physician had an opportunity to provide support or information to the family and did not. Fifteen family conferences (29%) had missed opportunities identified. These fell into three categories: opportunities to listen and respond to family; opportunities to acknowledge and address emotions; and opportunities to pursue key principles of medical ethics and palliative care, including exploration of patient preferences, explanation of surrogate decision making, and affirmation of nonabandonment. The most commonly missed opportunities were those to listen and respond, but examples from other categories suggest value in being aware of these opportunities. Identification of missed opportunities during ICU family conferences provides suggestions for improving communication during these conferences. Future studies are needed to demonstrate whether addressing these opportunities will improve quality of care.