title: Improving Caregivers' Perceptions Regarding Patient Goals of Care/End-of-Life Issues for the Multidisciplinary Critical Care Team.
abstract: OBJECTIVE
  With population aging and growth, use of critical care medicine at the end of life continues to rise, while many critical care providers are not adequately trained regarding goals of care/end-of-life (GOC/EOL) issues. A multidisciplinary intensive care unit (ICU) team intervention regarding GOC/EOL communication will enhance the clinical abilities of all critical care providers when discussing GOC/EOL issues and increase ICU staff comfort level while improving transitions for patients to a comfort care approach.
  
  
  METHODS
  This study was a preintervention/postintervention survey evaluation.
  
  
  METHODS
  This study was conducted at an academic tertiary surgical burn trauma ICU.
  
  
  METHODS
  The intervention was provided to nursing, ancillary staff, house staff, and attending physicians.
  
  
  METHODS
  An initial survey was circulated among the critical care staff for baseline expectations, satisfaction, and understanding of GOC/EOL care. A robust intervention was begun including the creation of a multidisciplinary GOC/EOL team, communication tools for providers, patient-family pamphlets, standardized EOL order sets, and formalized didactic sessions. Subsequently, the same survey was circulated and compared to baseline data.
  
  
  METHODS
  Preintervention/postintervention survey data were reviewed and statistically analyzed.
  
  
  RESULTS
  Our survey response rate for preintervention/postintervention was 50.4% and 36.1%, respectively. The intervention generated heightened interest in improving family communication and provided focal direction to foster this growth. Based on the serial surveys regarding our intervention, statistically significant staff improvements were seen in "work stress" (P = .04), "EOL information" (P = .006), and "space allotment" (P = .001). Improved congruence of families and health care providers regarding decision over intensity of care was also noted.
  
  
  CONCLUSIONS
  We created a novel unit-based multidisciplinary program for improved EOL/GOC approaches in the critical care setting. A similarly formatted program could be adapted by other ICUs. Benefits of such a program include improving caregivers' perceptions regarding EOL/GOC issues and fostering critical care team growth.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA wessmanb@anest.wustl.edu.|Division of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Wessman
authors.affiliation: Department of Nursing, Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Sona
authors.affiliation: Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Schallom
mesh_terms: D032722:Advance Care Planning; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003422:Critical Care / Q000458:organization & administration* / Q000592:standards; D016638:Critical Illness / Q000523:psychology*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D010174:Pamphlets; D010347:Patient Care Planning; D010361:Patients / Q000523:psychology*; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D013727:Terminal Care / Q000458:organization & administration* / Q000592:standards; D014481:United States
keywords: communication; education; end-of-life care; goals of care; multidisciplinary; order sets