title: Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction.
abstract: BACKGROUND
  There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development.
  
  
  METHODS
  Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar.
  
  
  RESULTS
  Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified.
  
  
  CONCLUSIONS
  Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
authors: 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
authors: Andrew W
authors: AW
authors: Schram
authors: 2 Battelle Memorial Institute, Seattle, WA, USA.
authors: Gavin W
authors: GW
authors: Hougham
authors: 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.|4 Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA.
authors: David O
authors: DO
authors: Meltzer
authors: 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
authors: Gregory W
authors: GW
authors: Ruhnke
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003422:Critical Care / Q000458:organization & administration* / Q000523:psychology; D004645:Empathy; D006801:Humans; D017008:Negotiating / Q000523:psychology; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011379:Prognosis; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology
keywords: conflict mediation; critical care; empathic communication; family-centered aspects of care; palliative care; patient satisfaction; prognostication