title: Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care.
abstract: BACKGROUND
  Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve.
  
  
  OBJECTIVE
  Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU).
  
  
  METHODS
  This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008). Nurses completed surveys for patients dying in the ICU. We examined associations between nurse-assessed predictors (physician-nurse communication, physician-family communication) and nurse ratings of patients' quality of dying (nurse-QODD-1).
  
  
  RESULTS
  Based on 1173 nurse surveys, four of six physician-nurse communication topics were positively associated with nurse-QODD-1: family questions, family dynamics, spiritual/religious issues, and cultural issues. Discussions between nurses and physicians about nurses' concerns for patients or families were negatively associated. All physician-family communication ratings, as assessed by nurses, were positively associated with nurse-QODD-1: answering family's questions, listening to family, asking about treatments patient would want, helping family decide patient's treatment wishes, and overall communication. Path analysis suggested overall physician-family communication and helping family incorporate patient's wishes were directly associated with nurse-QODD-1.
  
  
  CONCLUSIONS
  Several topics of physician-nurse communication, as rated by nurses, were associated with higher nurse-rated quality of dying, whereas one topic, nurses' concerns for patient or family, was associated with poorer ratings. Higher nurse ratings of physician-family communication were uniformly associated with higher quality of dying, highlighting the importance of this communication. Physician support of family decision making was particularly important, suggesting a potential target for interventions to improve end-of-life care.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Ramos
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.|2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.
authors.forename: Lois
authors.initials: L
authors.lastname: Downey
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.|2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nielsen
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.|2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.
authors.forename: Patsy D
authors.initials: PD
authors.lastname: Treece
authors.affiliation: 3 Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington , Seattle, Washington.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Shannon
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.|2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.|3 Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington , Seattle, Washington.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.|2 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011368:Professional-Family Relations; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*; D014861:Washington