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Reifarth E, Böll B, Kochanek M, Garcia Borrega J. Communication strategies for effective family-clinician conversations in the intensive care unit: A mixed methods study. Intensive Crit Care Nurs 2023; 79:103497. [PMID: 37542801 DOI: 10.1016/j.iccn.2023.103497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES To explore the perspectives of intensive care patients' family members and clinicians on conveying information during family-clinician conversations. SETTING Two medical intensive care units of a German academic tertiary care hospital. RESEARCH METHODOLOGY AND DESIGN This study followed a mixed methods design using a digital survey on family-clinician conversations with open- and closed-ended questions, metric scales, and free-text options. Quantitative analysis was performed to determine similarities and differences. Qualitative directed content analysis was conducted to code all free-text responses into themes. FINDINGS The responses of 100 family members, 42 nurses, and 28 physicians were analysed (response rate: 47%). All groups preferred face-to-face communication, the ask-tell-ask method, recipient design, and explaining medical terminology. The groups further commented on empathic communication by advocating the acknowledgement of the large amount of information. Qualitative themes highlighting the importance of bedside manners and written information were unique to the family members. Closed-ended questions were identified as potential trouble sources. Two communication strategies were rated as more suitable by the family members than by the physicians: being offered to choose between a summary or a detailed report at the beginning (p =.012;r = 0.288) and receiving a summary and having all questions answered at the end of a conversation (p =.023;r = 0.240). CONCLUSION The shared preferences supported existing expert recommendations, the differing preferences corroborated the importance of relational aspects of communication and additional written information. More research is needed on empathic communication aspects. IMPLICATIONS FOR CLINICAL PRACTICE To facilitate understanding, the clinicians may apply recipient design and the ask-tell-ask method, explain medical terminology, summarise important information, and proactively elicit questions. They may use empathic phrasing, demonstrate a respectful demeanour, and reflect on their current use of closed-ended questions and on the relational messages of their communication.
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Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Boris Böll
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
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Reifarth E, Garcia Borrega J, Kochanek M. How to communicate with family members of the critically ill in the intensive care unit: A scoping review. Intensive Crit Care Nurs 2023; 74:103328. [PMID: 36180318 DOI: 10.1016/j.iccn.2022.103328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits. METHODS We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding. RESULTS The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs. CONCLUSION The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.
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Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
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3
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Bernal OA, Roberts B, Wu DS. Interprofessional Interventions to Improve Serious Illness Communication in the Intensive Care Unit: A Scoping Review. Am J Hosp Palliat Care 2022:10499091221130755. [PMID: 36189871 DOI: 10.1177/10499091221130755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Serious illness communication is fundamental to the provision of quality care for patients in the intensive care unit (ICU). Evidence suggests that including interprofessional team members in such communication is beneficial. This scoping review--conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines-maps existing evidence regarding interprofessional interventions to improve serious illness communication in the ICU. The review yielded 14 studies for inclusion, which were organized by 3 thematic categories of strategies implemented: training curriculum, scheduled meetings, and liaison role. Most used a combination of intervention strategies. Outcome measures varied across the studies but could be broadly categorized as patient/family-focused, provider-focused, or systems-focused. Great heterogeneity between studies exists. More research is needed.
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Affiliation(s)
- Olivia A Bernal
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Roberts
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA.,Palliative Care Program, 23238Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - David S Wu
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA.,Palliative Care Program, 23238Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Bülow H, Petersen H, Benbenishty J, Sprung CL. Hints and advice on end-of-life communication in the ICU, also during pandemics. Acta Anaesthesiol Scand 2021; 65:1143-1146. [PMID: 33964014 DOI: 10.1111/aas.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hans‐Henrik Bülow
- Department of Anaesthesiology and Intensive Care Holbæk Hospital Holbæk Denmark
| | - Helle Petersen
- Department of Design and Communication The University of Southern Denmark Odense Denmark
| | - Julie Benbenishty
- Faculty of Medicine Department of Anesthesiology Critical Care and Pain Medicine Hadassah Medical Center Hebrew University of Jerusalem Jerusalem Israel
| | - Charles L. Sprung
- Faculty of Medicine Department of Anesthesiology Critical Care and Pain Medicine Hadassah Medical Center Hebrew University of Jerusalem Jerusalem Israel
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Vigué B, Radiguer F. Dialogue avec l’entourage des patients en réanimation. LE PRATICIEN EN ANESTHÉSIE RÉANIMATION 2020; 24:250-258. [PMID: 32982543 PMCID: PMC7508493 DOI: 10.1016/j.pratan.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La place donnée à l’entourage de nos patients a accompli un changement profond dans les réanimations. Travailler à des discussions collégiales avec les soignants, reconnaître la parole des patients mais aussi de leurs proches dans les projets de soins est devenu une part obligatoire de notre travail quotidien. Ce changement de considération se perçoit aussi dans l’attention accordée aux partages des décisions éthiques. La confiance dans le système de soins comme auprès des intervenants médicaux est nécessaire pour que la relation thérapeutique puisse se faire sereinement. Il nous faut donc s’organiser pour perfectionner l’accueil des familles, la place de l’équipe, les réunions formelles régulières d’information auprès des proches ou du représentant de notre patient. Le stress post traumatique n’est pas seulement l’apanage des patients rescapés de réanimation, il est décrit aussi chez les accompagnants. Si la confiance est acquise, peu de conflits avec la famille sont insurmontables, seuls les conflits interfamiliaux obligent l’équipe médicale à défendre son opinion. La prise de conscience qu’un projet de soin à la sortie de réanimation réussira mieux quand il se fait avec l’appui de l’entourage, permet de comprendre l’importance à accorder aux proches et à leur stress.
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Pereira LCV, Ercig B, Kangro K, Jamme M, Malot S, Galicier L, Poullin P, Provôt F, Presne C, Kanouni T, Servais A, Benhamou Y, Daguindau N, Vanhoorelbeke K, Azoulay E, Veyradier A, Coppo P. Understanding the Health Literacy in Patients With Thrombotic Thrombocytopenic Purpura. Hemasphere 2020; 4:e462. [PMID: 32885148 PMCID: PMC7430230 DOI: 10.1097/hs9.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Following an acute thrombotic thrombocytopenic purpura (TTP) episode, patients are at risk for relapse, and a careful long-term follow-up is needed. Adherence to the follow-up by patients implies a good understanding of the disease. However, TTP literacy in patients is currently unknown. To explore the TTP literacy in patients and identify factors associated with poor disease understanding, a questionnaire was developed focusing on patient's characteristics, knowledge about TTP and patients' actions in an emergency. The questionnaire was presented to 120 TTP patients in remission from the French National Registry for Thrombotic Microangiopathies. TTP literacy was low in 24%, intermediate in 43% and high in 33% of the patients. Low TTP literacy was associated with older age and low education level. Among the knowledge gaps identified, few patients knew that plasma exchange in acute phase is mandatory and has to be done daily (39%), 47% of participants did not consider themselves at risk for relapse, and 30% of women did not know that pregnancy exposes them to a greater risk of relapse. Importantly, few patients responded about life-saving actions in an emergency. Hence, the design of educational material should pay special attention to the age and education level of the target population focusing on the events leading to TTP, the importance of the emergency treatment, controllable predisposing factors for TTP development and patient attitude in an emergency.
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Affiliation(s)
- Leydi C. Velasquez Pereira
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bogac Ercig
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Matthieu Jamme
- Médecine Intensive Réanimation-Néphrologie, CH de Poissy Saint Germain en Laye, Poissy, Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Paris-Sud University, Villejuif, France
| | - Sandrine Malot
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Université Paris-Diderot, Paris, France
- National Reference Center for Castleman Disease (CRMdC), Paris, France
- EA3518, Université Paris-Diderot, Paris, France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Department of Apheresis, Regional Reference Center for Thrombotic Microangiopathy, Aix-Marseille University, CHU de Marseille-Hôpital de la Conception, Marseille, France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Service de Néphrologie, Hôpital Albert Calmette, Lille, France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Service de Néphrologie, Hôpital Sud, CHU Amiens, Amiens, France
| | - Tarik Kanouni
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Service d’Hématologie, CHU Saint Eloi, Montpellier, France
| | - Aude Servais
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Service de Néphrologie–Dialyse Adulte, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Service de Médecine Interne, U1096, UNIROUEN, Normandie Universitaire, Rouen, France
| | | | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- Medical ICU, Saint-Louis Hospital, AP-HP, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- service d’Hématologie Biologique, Groupe Hospitalier Saint-Louis-Lariboisière, AP-HP, Université Paris-Diderot, Paris, France
- EA3518 Recherche Clinique en Hématologie, Immunologie et Transplantation, Équipe Microangiopathies Thrombotiques, ADAMTS13 et Facteur Willebrand, Institut de Recherche Saint-Louis, Université Paris-Diderot, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, AP-HP.6, Paris, France
- service d’Hématologie et Sorbonne Université, AP-HP.6, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris-Diderot, Paris, France
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7
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Ledoux M, Tricou C, Roux M, Dreano-Hartz S, Ruer M, Filbet M. Cancer Patients Dying in the Intensive Care Units and Access to Palliative Care. J Palliat Med 2018; 21:689-693. [PMID: 29480751 DOI: 10.1089/jpm.2017.0415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In France, cancer has become the leading cause of death. Intensive care units (ICU) focus on survival, which may not be an appropriate setting to provide palliative care (PC) as needed by cancer patients and families. OBJECTIVE To describe the cancer patients who died in the ICU in 2010 in a French academic medical center. DESIGN Retrospective study Measurements: We reviewed medical records of all cancer patients who died in the ICU in 2010. The information collected from electronic medical records included patient sociodemographics and clinical characteristics, PC service referral, and the date of first contact with PC. RESULTS Among the 536 cancer patients who died in 2010, 42 (8%) died in the ICU. The cancers were hematological (21%), gastrointestinal (21%) and head and neck (21%). One patient had a PC referral versus 45% in the total population (p < 0.001) and the referral was the same day as the death. Eight (19%) patients had chemotherapy during their last month of life and 2 during the ICU hospitalization. Seventy-four per cent of patient admissions to the ICU related directly to malignancy. The mean time between diagnosis of cancer and death was 2.3 years (standard deviation, 4.4). CONCLUSIONS Our work highlights the need for early PC in the illness trajectory of cancer patients to prevent the transfer of dying patients to the ICU. More studies are needed to understand the decision making leading to such transfers.
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Affiliation(s)
- Mathilde Ledoux
- 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France .,2 Palliative Care Unit, L'Hôpital Nord Ouest , Trévoux, France
| | - Colombe Tricou
- 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France
| | - Maxime Roux
- 3 Department of Anesthesiology, L'Hôpital Nord Ouest , Villefranche sur Saône, France
| | - Soazic Dreano-Hartz
- 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France
| | - Murielle Ruer
- 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France
| | - Marilène Filbet
- 1 Department of Palliative Care, Centre Hospitalier de Lyon-Sud , Hospices Civils de Lyon, Lyon, France
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Que comprennent les patients laissés sur place par le Smur quant aux informations communiquées par le médecin ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Desmettre T. De l’information à la compréhension : une affaire de spécialistes. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Schrooten I, de Jong MDT. If You Could Read My Mind: The Role of Healthcare Providers' Empathic and Communicative Competencies in Clients' Satisfaction with Consultations. HEALTH COMMUNICATION 2017; 32:111-118. [PMID: 27177385 DOI: 10.1080/10410236.2015.1110002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article investigates the relationship between healthcare providers' empathic and communicative competencies and clients' overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients' perspective) and empathic skills (ability to estimate clients' evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients' scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients' overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers' empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients' overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.
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Affiliation(s)
- Iete Schrooten
- a Department of Communication Science , University of Twente
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11
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Mistraletti G, Umbrello M, Mantovani ES, Moroni B, Formenti P, Spanu P, Anania S, Andrighi E, Di Carlo A, Martinetti F, Vecchi I, Palo A, Pinna C, Russo R, Francesconi S, Valdambrini F, Ferretti E, Radeschi G, Bosco E, Malacarne P, Iapichino G. A family information brochure and dedicated website to improve the ICU experience for patients' relatives: an Italian multicenter before-and-after study. Intensive Care Med 2016; 43:69-79. [PMID: 27830281 DOI: 10.1007/s00134-016-4592-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Good communication between ICU staff and patients' relatives may reduce the occurrence of post-traumatic stress disorder, anxiety or depression, and dissatisfaction with clinicians. An information brochure and website to meet relatives' needs were designed to explain in technical yet simple terms what happens during and after an ICU stay, to legitimize emotions such as fear, apprehension, and suffering, and to improve cooperation with relatives without increasing staff workload. The main outcomes were improved understanding of prognosis and procedures, and decrease of relatives' anxiety, depression, and stress symptoms. METHODS In this prospective multicenter before-and-after study, a self-administered questionnaire was used to investigate relatives' understanding of prognosis, treatments, and organ dysfunction, families' satisfaction, and symptoms of anxiety, depression, and post-traumatic stress. RESULTS A total of 551 relatives received questionnaires in nine Italian ICUs; 332 (60%) responded, 144 before and 179 after implementation of the brochure and website. Of the 179 relatives who responded after, 131 (73%) stated they had read the brochure and 34 (19%) reported viewing the website. The intervention was associated with increased correct understanding of the prognosis (from 69 to 84%, p = 0.04) and the therapeutic procedures (from 17 to 28%, p = 0.03). Multivariable analysis, together with non-modifiable factors (relative's gender, education level, relationship to patient, and patient status at ICU discharge), showed the intervention to be significantly associated with a lower incidence of post-traumatic stress symptoms (Poisson coefficient = -0.29, 95% CI -0.52/-0.07). The intervention had no effect on the prevalence of symptoms of anxiety and depression. CONCLUSION An information brochure and website designed to meet relatives' needs improved family members' comprehension and reduced their prevalence of stress symptoms.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy. .,U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
| | - Michele Umbrello
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Elena Silvia Mantovani
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Benedetta Moroni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy
| | - Paolo Formenti
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Paolo Spanu
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Stefania Anania
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Elisa Andrighi
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Alessandra Di Carlo
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Federica Martinetti
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Irene Vecchi
- U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
| | - Alessandra Palo
- U.O. Anestesia e Rianimazione 1, I.R.C.C.S. San Matteo, Pavia, Italy
| | - Cristina Pinna
- U.O. Anestesia e Rianimazione, Dipartimento di Area Critica, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy
| | - Riccarda Russo
- U.O.C. Rianimazione e Terapia Intensiva, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Francesconi
- U.O.C. Anestesia e Rianimazione, A. O. Ospedale Civile di Desio, Desio, Milan, Italy
| | - Federico Valdambrini
- U.O. Anestesia e Rianimazione, A.O. Ospedale Civile di Legnano, Legnano, Milan, Italy
| | - Enrica Ferretti
- S.C. Anestesia Rianimazione B DEA, Ospedale San Giovanni Bosco, Turin, Italy
| | - Giulio Radeschi
- U.O. Anestesia e Rianimazione, A.O. U. San Luigi Gonzaga di Orbassano, Orbassano, Turin, Italy
| | - Edda Bosco
- U.O. Anestesia e Rianimazione, A.O. Cardinal Massaia, Asti, Italy
| | - Paolo Malacarne
- U.O. Anestesia e Rianimazione-P.S, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Gaetano Iapichino
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy.,U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy
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Khan A, Rogers JE, Forster CS, Furtak SL, Schuster MA, Landrigan CP. Communication and Shared Understanding Between Parents and Resident-Physicians at Night. Hosp Pediatr 2016; 6:319-29. [PMID: 27188189 DOI: 10.1542/hpeds.2015-0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. METHODS We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients' reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding. RESULTS We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively. CONCLUSIONS Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Mark A Schuster
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher P Landrigan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 2016; 42:725-738. [PMID: 27025938 DOI: 10.1007/s00134-016-4321-8] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge. Cognitive impairment in ARDS survivors ranges from 70 to 100 % at hospital discharge, 46 to 80 % at 1 year, and 20 % at 5 years, and mood disorders including depression and post-traumatic stress disorder (PTSD) are also sustained and prevalent. Robust multidisciplinary and longitudinal interventions that improve these outcomes are still uncertain and data in our literature are conflicting. Studies are needed in family members of ARDS survivors to better understand long-term outcomes of the post-ICU family syndrome and to evaluate how it affects patient recovery.
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Affiliation(s)
- Margaret S Herridge
- Critical Care and Respiratory Medicine, Toronto General Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine L Hough
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ramona O Hopkins
- Psychology Department, Brigham Young University, Provo, UT, USA.,Neuroscience Center, Brigham Young University, Provo, UT, USA.,Department of Medicine, Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.,Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Department of Medicine, Nashville, TN, USA
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elie Azoulay
- Medical ICU of the Saint-Louis Hospital, Paris Diderot Sorbonne University, Paris, France
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L’enseignement de la réanimation au sein du DESC de médecine d’urgence en France : état des lieux et perspectives. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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