title: An Integrated Framework for Effective and Efficient Communication with Families in the Adult Intensive Care Unit.
abstract: The increased focus on patient and family-centered care in adult intensive care units (ICUs) has generated multiple platforms for clinician-family communication beyond traditional interdisciplinary family meetings (family meetings)-including family-centered rounds, bedside or telephone updates, and electronic family portals. Some clinicians and administrators are now using these platforms instead of conducting family meetings. For example, some institutions are moving toward using family-centered rounds as the main platform for clinician-family communication, and some physicians rely on brief daily updates to the family at the bedside or by phone, in lieu of family meetings. We argue that although each of these platforms is useful in some circumstances, there remains an important role for family meetings. We outline five goals of clinician-family communication-establishing trust, providing emotional support, conveying clinical information, understanding the patient as a person, and facilitating careful decision making-and we examine the extent to which various communication platforms are likely to achieve the goals. We argue that because no single platform can achieve all communication goals, an integrated strategy is needed. We present a model that integrates multiple communication platforms to effectively and efficiently support families across the arc of an ICU stay. Our framework employs bedside/telephone conversations and family-centered rounds throughout the admission to address high informational needs, along with well-timed family meetings that attend to families' emotions as well as patients' values and goals. This flexible model uses various communication platforms to achieve consistent, efficient communication throughout the ICU stay.
authors.affiliation: 1 Program on Ethics and Decision Making, Department of Critical Care Medicine, and.
authors.forename: Jennifer B
authors.identifier: http://orcid.org/0000-0002-2461-5590
authors.initials: JB
authors.lastname: Seaman
authors.affiliation: 2 Section of Palliative Care and Medical Ethics, Department of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|3 Palliative and Supportive Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: 4 Division of Geriatric Medicine and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Scheunemann
authors.affiliation: 1 Program on Ethics and Decision Making, Department of Critical Care Medicine, and.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D000328:Adult; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D018802:Patient-Centered Care; D011368:Professional-Family Relations
keywords: communication; decision-making; family conference; family meetings; family-centered rounds; intensive care unit