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KEY POINTS
Offering palliative care is an integral part of good ICU care.
A script for running an effective family meeting in the ICU may include a format like ASK–TELL–ASK.
Provide important pieces of information one section at a time, then wait and listen for a response.
In addition to disease-targeted interventions, always provide palliative options when appropriate.
During a family meeting after you have elicited input from all participants, make treatment recommendations based on the values and preferences expressed.
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One of the most important responsibilities of health care providers in the intensive care unit (ICU) is effective communication with seriously ill patients and their family members. Generally, ICU patients are unable to participate in medical decision-making. Therefore, discussions about prognosis and treatments are often held with family members. In this chapter, the term family member will be used to describe related family members, loved ones, or legal surrogates responsible for medical decision-making on behalf of the patient. The ICU family meeting should generally occur within 72 hours of ICU admission. Family meetings are associated with increased patient, family and provider satisfaction with the type of care received, and more preference congruent care. We outline key strategies for conducting meaningful and effective ICU family meetings.
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IMPACT OF EFFECTIVE COMMUNICATION
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Patients with an advance directive, or patients who participate in discussions with their doctor about their preferences for care as their disease progresses, receive less intensive care in the final weeks of life, are less likely to die in the hospital or ICU, and have improved quality of life.1 Unfortunately, most patients in the ICU have not had prior discussions regarding their treatment preferences in the outpatient setting or on the medical and surgical floors with health care providers. These difficult conversations are therefore often left to members of the ICU team. Although earlier conversations about treatment preferences is preferred, studies show that patients and family members respond well to anyone with good communication skills, even if the provider does not have an established relationship with the patient or family. In fact, an ICU provider trained in effective communication may conduct a more successful family meeting than the primary physician.
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Family satisfaction is directly impacted by effective communication strategies. Factors associated with increased satisfaction include high-quality communication, consistent information from all caregivers, use of empathetic statements, decision-making support, and family-centered care. Patient survival alone is not always correlated with increased family satisfaction.2 The mnemonic VALUE has been developed to help providers better understand and manage family emotion during interactions and family meetings. The use of VALUE in a large ICU study during family meetings for patients who eventually died in the ICU showed that the surviving family members experienced less post-traumatic stress disorder, anxiety, and depression several months after the death of their loved one when these communication strategies were used. VALUE ...