TY - JOUR
T1 - Communication of prognostic information for critically Ill patients
AU - LeClaire, Michele M.
AU - Oakes, J. Michael
AU - Weinert, Craig R.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2005/9
Y1 - 2005/9
N2 - Study objectives: The purpose of this study was to determine whether the timing of prognostic information delivery by physicians is associated with caregiver satisfaction with communication or decision making in the ICU. Design: Multicenter, prospective, longitudinal observational study. Setting: Medical and surgical ICUs in a community and university hospital. Participants: Decision makers for critically ill patients. Measurements and results: Longitudinal surveys assessed both actual and desired frequency of communication with physicians, timing and content of physician prognosis, and subject satisfaction with physician communication and subject's role in decision making. Seventy subjects were enrolled and completed 216 surveys. Fifty-seven caregivers (81%) received prognostic information during the ICU stay, with a mean time between ICU admission and provision of prognostic information (prognostic interval) of 1.7 ± 2.8 days (median, 1 day). This interval was not associated with patient age, severity of illness, clinical service, hospital, socioeconomic status, or prior patient ICU admission. A shorter prognostic interval was associated with increased satisfaction with communication, with a trend toward statistical significance (p = 0.06). Both the measured communication rate (p < 0.001) and subjects' desired communication rate with physicians decreased over time in the ICU (p < 0.001). Although 78% of subjects rated their overall satisfaction with frequency of communication as "good," "very good," or "excellent," their satisfaction with communication frequency decreased with time in the ICU (p = 0.006). Conclusions: Families of critically ill patients were generally satisfied with communication in the ICU; however, 19% were unable to recall receiving any prognostic information from physicians. Providing all decision makers with some prognostic information, even if it consists of a statement of uncertainty (as was commonly done in this study), may further improve satisfaction with ICU care. A widening gap between the actual and desired communication rate may result in a decline in communication satisfaction over the course of the ICU stay. This suggests that the capacity of physicians and other ICU personnel to manage families' communication expectations may positively influence caregiver satisfaction.
AB - Study objectives: The purpose of this study was to determine whether the timing of prognostic information delivery by physicians is associated with caregiver satisfaction with communication or decision making in the ICU. Design: Multicenter, prospective, longitudinal observational study. Setting: Medical and surgical ICUs in a community and university hospital. Participants: Decision makers for critically ill patients. Measurements and results: Longitudinal surveys assessed both actual and desired frequency of communication with physicians, timing and content of physician prognosis, and subject satisfaction with physician communication and subject's role in decision making. Seventy subjects were enrolled and completed 216 surveys. Fifty-seven caregivers (81%) received prognostic information during the ICU stay, with a mean time between ICU admission and provision of prognostic information (prognostic interval) of 1.7 ± 2.8 days (median, 1 day). This interval was not associated with patient age, severity of illness, clinical service, hospital, socioeconomic status, or prior patient ICU admission. A shorter prognostic interval was associated with increased satisfaction with communication, with a trend toward statistical significance (p = 0.06). Both the measured communication rate (p < 0.001) and subjects' desired communication rate with physicians decreased over time in the ICU (p < 0.001). Although 78% of subjects rated their overall satisfaction with frequency of communication as "good," "very good," or "excellent," their satisfaction with communication frequency decreased with time in the ICU (p = 0.006). Conclusions: Families of critically ill patients were generally satisfied with communication in the ICU; however, 19% were unable to recall receiving any prognostic information from physicians. Providing all decision makers with some prognostic information, even if it consists of a statement of uncertainty (as was commonly done in this study), may further improve satisfaction with ICU care. A widening gap between the actual and desired communication rate may result in a decline in communication satisfaction over the course of the ICU stay. This suggests that the capacity of physicians and other ICU personnel to manage families' communication expectations may positively influence caregiver satisfaction.
KW - Communication
KW - Critical care
KW - End of life
KW - Family satisfaction
KW - ICU
KW - Prognosis
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U2 - 10.1378/chest.128.3.1728
DO - 10.1378/chest.128.3.1728
M3 - Article
C2 - 16162781
AN - SCOPUS:24944444102
SN - 0012-3692
VL - 128
SP - 1728
EP - 1735
JO - CHEST
JF - CHEST
IS - 3
ER -