End-of-life communication in the intensive care unit

• Published in: General hospital psychiatry 2010-07, Vol.32 (4), p.433-442
• Main Authors: Levin, Tomer T., M.B., B.S, Moreno, Beatriz, M.A, Silvester, William, M.B., B.S, Kissane, David W., M.D
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical Competence; Clinical death. Palliative care. Organ gift and preservation; Communication; Communication Barriers; Communication skills training; Death and dying; Emergency and intensive care: techniques, logistics; End-of-life communication; Family - psychology; Family communication; Health staff related problems. Vocational training; Humans; Intensive care medicine; Intensive care unit; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Intensive Care Units; Medical sciences; Palliative care; Palliative Care - psychology; Physician-Patient Relations - ethics; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Resuscitation Orders - ethics; Social psychiatry. Ethnopsychiatry; Terminal Care - ethics; Terminal Care - psychology
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2010.04.007

Abstract Objective Because one in five Americans die in the intensive care unit (ICU), the potential role of palliative care is considerable. End-of-life (EOL) communication is essential for the implementation of ICU palliative care. The objective of this review was to summarize current research and recommendations for ICU EOL communication. Design For this qualitative, critical review, we searched PubMed, Embase, Cochrane, Ovid Medline, Cinahl and Psychinfo databases for ICU EOL communication clinical trials, systematic reviews, consensus statements and expert opinions. We also hand searched pertinent bibliographies and cross-referenced known EOL ICU communication researchers. Results Family-centered communication is a key component of implementing EOL ICU palliative care. The main forum for this is the family meeting, which is an essential platform for implementing shared decision making, e.g., transitioning from curative to EOL palliative goals of care. Better communication can improve patient outcomes such as reducing psychological trauma symptoms, depression and anxiety; shortening ICU length of stay; and improving the quality of death and dying. Communication strategies for EOL discussions focus on addressing family emotions empathically and discussing death and dying in an open and meaningful way. Central to this is viewing ICU EOL palliative care and withdrawal of life-extending treatment as predictable and not an unexpected emergency. Conclusions Because the ICU is now a well-established site for death, ICU physicians should be trained with EOL communication skills so as to facilitate palliative care more hospitably in this challenging setting. Patient/family outcomes are important ways of measuring the quality of ICU palliative care and EOL communication.