Missed opportunities during family conferences about end-of-life care in the intensive care unit.
BACKGROUND
Improved communication with family members of critically ill patients can decrease the prolongation of dying in the intensive care unit (ICU), but few data exist to guide the conduct of this communication.


OBJECTIVE
Our objective was to identify missed opportunities for physicians to provide support for or information to family during family conferences.


METHODS
We identified ICU family conferences in four hospitals that included discussions about withdrawing life support or delivery of bad news. Fifty-one conferences were audiotaped, including 214 family members. Thirty-six physicians led the conferences and some physicians led more than one. We used qualitative methods to identify and categorize missed opportunities, defined as an occurrence when the physician had an opportunity to provide support or information to the family and did not.


RESULTS
Fifteen family conferences (29%) had missed opportunities identified. These fell into three categories: opportunities to listen and respond to family; opportunities to acknowledge and address emotions; and opportunities to pursue key principles of medical ethics and palliative care, including exploration of patient preferences, explanation of surrogate decision making, and affirmation of nonabandonment. The most commonly missed opportunities were those to listen and respond, but examples from other categories suggest value in being aware of these opportunities.


CONCLUSIONS
Identification of missed opportunities during ICU family conferences provides suggestions for improving communication during these conferences. Future studies are needed to demonstrate whether addressing these opportunities will improve quality of care.
Curtis
J Randall
JR
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. jrc@u.washington.edu
Engelberg
Ruth A
RA
Wenrich
Marjorie D
MD
Shannon
Sarah E
SE
Treece
Patsy D
PD
Rubenfeld
Gordon D
GD
D000328:Adult; D016223:Advance Directives / Q000941:ethics / Q000523:psychology*; D000368:Aged; D003142:Communication; D004644:Emotions; D004645:Empathy; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D007872:Legal Guardians / Q000523:psychology; D008020:Life Support Care / Q000941:ethics / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics / Q000523:psychology; D010348:Patient Care Team / Q000941:ethics; D010819:Physician's Role / Q000523:psychology*; D011368:Professional-Family Relations / Q000941:ethics; D011785:Quality Assurance, Health Care / Q000941:ethics; D013727:Terminal Care / Q000941:ethics / Q000523:psychology*; D028761:Withholding Treatment / Q000941:ethics