title: Responding to families' questions about the meaning of physical movements in critically ill patients.
abstract: BACKGROUND
  Families may have questions about the meaning of physical movement in critically ill patients for whom movements are likely involuntary. If unresolved, these questions may contribute to difficult communication around end-of-life care. This study used qualitative methods to describe physicians' responses to families' questions about the meaning of patients' movements in critically ill patients.
  
  
  METHODS
  Fifty-one family conferences in which withdrawal of life support or discussion of bad news was addressed were audiotaped and analyzed with a limited application of grounded theory techniques. Patients were identified from intensive care units in 4 Seattle area hospitals. Two hundred twenty-seven family members and 36 physicians participated in the study.
  
  
  RESULTS
  Family members' questions indicating lack of resolution about the meaning of patients' movements that were likely involuntary occurred in 6 (12%) of the 51 conferences. Physicians used 3 approaches to respond to the following questions: (1) providing clinical information, (2) acknowledging families' emotions, and (3) exploring the meaning of families' emotions. Physicians were most likely to provide clinical information in these situations and infrequently explored the meaning of families' emotions.
  
  
  CONCLUSIONS
  Physicians' responses to family questions indicating lack of resolution about the meaning of patients' movements that were likely involuntary can be categorized into 3 types. Physicians may be better able to respond to and resolve these questions by using all 3 types of communication approaches. Future studies should determine if such responses can improve families' experiences and other outcomes.
authors.affiliation: Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98104, USA. rengel@u.washington.edu
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.forename: Marjorie D
authors.initials: MD
authors.lastname: Wenrich
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D016638:Critical Illness; D004644:Emotions; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D011368:Professional-Family Relations; D011446:Prospective Studies; D012018:Reflex; D013727:Terminal Care