Intensivist-reported Facilitators and Barriers to Discussing Post-Discharge Outcomes with Intensive Care Unit Surrogates. A Qualitative Study.
Intensive care unit (ICU) patients' expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families.



To characterize intensivist-identified barriers and facilitators to discussing post-discharge outcomes with surrogates of ICU patients.



Qualitative study conducted via one-on-one, semistructured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education-accredited critical care medicine programs in 16 states. A limited application of grounded theory methods was used to code transcribed interviews and identify themes and illustrative quotes.



Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes for an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-discharge outcomes with ICU surrogates: (1) incorrectly optimistic expectations for recovery among ICU surrogates, (2) having little or no contact with their patients after ICU discharge, and (3) minimal confidence applying existing outcomes research to individual patients. Despite these barriers, experience talking to ICU surrogates, seeing ICU survivors in the outpatient setting, and trusted research on functional outcomes were identified as important facilitators to discussing likely patient outcomes with surrogates. Intensivists generally welcomed questions from surrogates about post-discharge outcomes as opportunities to initiate conversations about prognosis and patient values.



In this sample of intensivists from 20 academic hospitals, experience conducting conversations with surrogates and interactions with ICU survivors as outpatients were identified as facilitating discussion of expected post-discharge outcomes while optimistic surrogate expectations and prognostic uncertainty were barriers. There was tension between self-perceived ability to prognosticate and belief in a professional obligation to discuss patient outcomes.
1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.|3 Department of Epidemiology, Bloomberg School of Public Health, and.
Alison E
0000-0002-1564-6547
AE
Turnbull
1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.
Wesley E
WE
Davis
1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.|4 Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Dale M
DM
Needham
5 Center for Bioethics and Health Law, Department of Critical Care Medicine.|6 Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, and.|7 Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Douglas B
DB
White
1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.
Michelle N
MN
Eakin
D000066491:Clinical Decision-Making; D003144:Communication Barriers; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000379:methods*; D011368:Professional-Family Relations; D011379:Prognosis; D036301:Qualitative Research; D016896:Treatment Outcome
communication barriers; critical care; patient-centered care; prognosis; surrogate decision-making