Family Survey of Understanding and Communication of Patient Prognosis in the Intensive Care Unit: Identifying Training Opportunities

An evaluation of surrogate decision maker health literacy in the neurology ward and neuroscience ICU

PURPOSE

There has been little investigation into surrogate comprehension of education provided by the neuroscience healthcare team. We sought to evaluate 1) surrogate understanding about a patient's clinical condition and 2) the relationship between how surrogates and the neuroscience team perceive surrogate comprehension of a patient's condition.

METHODS

We prospectively surveyed surrogates of patients who lacked decision making capacity while admitted to the neurology ward or neuroscience ICU for >48 h from 10/2018-05/2021. The survey investigated the surrogate's communication with the neuroscience team and understanding of the hospitalization. A member of the neuroscience team was asked to provide clinical data about the patient and indicate how well they perceived the surrogate understood the situation.

RESULTS

We surveyed 50 surrogates at a median of 10 (IQR 5-17) days after hospitalization. There were 38 (76%) surrogates who correctly identified the reason for admission, and 21 (42%) who correctly identified all the assessments/interventions performed. Nearly all surrogates rated their understanding of the patient's medical condition as excellent (47%) or good (49%). There was no to slight agreement (kappa = 0.133) between surrogate self-perception of understanding and neuroscience team perception of the surrogate's understanding. Although only 20% of surrogates used institutional electronic education materials, 74% discussed the hospitalization with friends/family who work in healthcare.

CONCLUSION

Objective and subjective assessments of surrogate comprehension demonstrate that there is a need to improve communication with the surrogates of patients with neurological conditions. Neuroscience healthcare teams must be taught how to educate surrogates and assess their understanding.

Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea

Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.