title: Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction.
abstract: OBJECTIVE
  Family members of critically ill patients report dissatisfaction with family-clinician communication about withdrawing life support, yet limited data exist to guide clinicians in this communication. The hypothesis of this analysis was that increased proportion of family speech during ICU family conferences would be associated with increased family satisfaction.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We identified family conferences in intensive care units of four Seattle hospitals during which discussions about withdrawing life support were likely to occur.
  
  
  METHODS
  Participants were 214 family members from 51 different families. There were 36 different physicians leading the conferences, as some physicians led more than one conference.
  
  
  METHODS
  Fifty-one conferences were audiotaped.
  
  
  METHODS
  We measured the duration of time that families and clinicians spoke during the conference. All participants were given a survey assessing satisfaction with communication.
  
  
  RESULTS
  The mean conference time was 32.0 mins with an sd of 14.8 mins and a range from 7 to 74 mins. On average, family members spoke 29% and clinicians spoke 71% of the time. Increased proportion of family speech was significantly associated with increased family satisfaction with physician communication. Increased proportion of family speech was also associated with decreased family ratings of conflict with the physician. There was no association between the duration of the conference and family satisfaction.
  
  
  CONCLUSIONS
  This study suggests that allowing family members more opportunity to speak during conferences may improve family satisfaction. Future studies should assess the effect of interventions to increase listening by critical care clinicians on the quality of communication and the family experience.
authors.affiliation: Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: McDonagh
authors.forename: Tricia B
authors.initials: TB
authors.lastname: Elliott
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.forename: Patsy D
authors.initials: PD
authors.lastname: Treece
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Shannon
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Donald L
authors.initials: DL
authors.lastname: Patrick
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D003142:Communication; D003258:Consumer Behavior; D003422:Critical Care; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D014861:Washington