title: A systematic review of communication quality improvement interventions for patients with advanced and serious illness.
abstract: BACKGROUND
  Effective communication is an interaction between two or more people that produces a desired effect and is a key element of quality of care for patients with advanced and serious illness and their family members. Suboptimal provider-patient/family communication is common, with negative effects on patient/family-centered outcomes.
  
  
  OBJECTIVE
  To systematically review the evidence for effectiveness of communication-related quality improvement interventions for patients with advanced and serious illness and to explore the effectiveness of consultative and integrative interventions.
  
  
  METHODS
  MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011 and reference list of eligible articles and reviews.
  
  
  METHODS
  Prospective, controlled quality improvement studies in populations with life-limiting or severe life-threatening illness with a primary intervention focus of improving communication with patients and/or families.
  
  
  METHODS
  Two investigators independently screened and abstracted data on patient/family-centered outcomes.
  
  
  RESULTS
  We included 20 studies; 13 (65 %) were in intensive care. We found four intervention types: (1) family meetings with the usual team (11 studies, 77 % found improvement in healthcare utilization), (2) palliative care teams (5 studies, 50 % found improvement in healthcare utilization), (3) ethics consultation (2 studies, 100 % found improvement in healthcare utilization), and (4) physician-patient communication (2 studies, no significant improvement in healthcare utilization). Among studies addressing the outcomes of patient/family satisfaction, 22 % found improvement; among studies addressing healthcare utilization (e.g., length of stay), 73 % found improvement. Results suggest that consultative interventions, as opposed to integrative ones, may be more effective, but more research is needed.
  
  
  CONCLUSIONS
  Study heterogeneity did not allow quantitative synthesis.
  
  
  CONCLUSIONS
  Communication in the care of patients with advanced and serious illness can be improved using quality improvement interventions, particularly for healthcare utilization as an outcome. Interventions may be more effective using a consultative approach.
authors.affiliation: Johns Hopkins University Evidence-Based Practice Center, 1830 East Monument Street, Room 8065, Baltimore, MD 21287, USA. ofawole1@jhmi.edu
authors.forename: Oluwakemi A
authors.initials: OA
authors.lastname: Fawole
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
authors.forename: Renee F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Martinez
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Apostol
authors.forename: Daniela
authors.initials: D
authors.lastname: Vollenweider
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Aslakson
mesh_terms: D003142:Communication; D003422:Critical Care / Q000592:standards; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D006801:Humans; D010166:Palliative Care / Q000592:standards*; D017060:Patient Satisfaction; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D058996:Quality Improvement