Studying communication about end-of-life care during the ICU family conference: development of a framework.
OBJECTIVE
Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted.


METHODS
We identified family conferences in the ICUs of 4 Seattle-area hospitals. Conferences were eligible if the physician leading the conference believed that discussion about withholding or withdrawing life support or the delivery of bad news was likely to occur and if all conference participants consented to participate. Fifty conferences were audiotaped, transcribed, and analyzed by using the principles of grounded theory.


RESULTS
We developed 2 frameworks for describing and understanding this communication. The first framework describes communication content, including introductions, information exchange, discussions of the future, and closings. The second framework describes communication styles and support provided to families and other clinicians and includes a variety of techniques such as active listening, acknowledging informational complexity and emotional difficulty of the situation, and supporting family decision making. These frameworks identify what physicians discuss, how they present and respond to issues, and how they support families during these conferences.


CONCLUSIONS
This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.
Curtis
J Randall
JR
Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA. jrc@u.washington.edu
Engelberg
Ruth A
RA
Wenrich
Marjorie D
MD
Nielsen
Elizabeth L
EL
Shannon
Sarah E
SE
Treece
Patsy D
PD
Tonelli
Mark R
MR
Patrick
Donald L
DL
Robins
Lynne S
LS
McGrath
Barbara B
BB
Rubenfeld
Gordon D
GD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010347:Patient Care Planning; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D014861:Washington; D028761:Withholding Treatment