Challenges in delivering bad news in a multi-ethnic intensive care unit: An ethnographic study

Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study

OBJECTIVES

To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations.

RESEARCH METHODOLOGY/DESIGN

Mixed-methods survey study.

SETTING

Two medical ICUs of a German academic tertiary care hospital.

MAIN OUTCOME MEASURES

Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis.

FINDINGS

The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p =.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p =.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p =.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest.

CONCLUSION

The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.

How do cultural factors influence the provision of end-of-life care? A narrative review

BACKGROUND

Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life.

OBJECTIVE

Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life?

METHODS

A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included.

RESULTS

A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism).

CONCLUSIONS

These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.

Understanding equitable and affirming communication moments and relationship milestones during the intensive care unit journey: findings from stage 1 of a design thinking project

PURPOSE

Communication is vital to facilitate patient and family-centred care (PFCC) and to build trusting relationships between intensive care unit (ICU) health care providers, the patient, and their loved ones in the ICU. The focus of this investigation was to identify, define, and refine key moments of communication, connection, and relationship building in the ICU through a lens of Equity, Diversity, Decolonization, and Inclusion (EDDI) to encourage meaningful communication and development of trusting relationships.

METHODS

We conducted 13 journey mapping interviews with ICU health care providers, patients, and their loved ones as the first stage in a design thinking project. We used directed content analysis to identify intersections where principles of EDDI directly or indirectly impacted communication, relationships, and trust throughout the ICU journey. To serve diverse patients and their loved ones, accessibility, inclusivity, and cultural safety were foundational pillars of the design thinking project.

RESULTS

Thirteen ICU health care providers, patients, and their loved ones participated in journey mapping interviews. We defined and refined 16 communication moments and relationship milestones in the journey of a patient through the ICU (e.g., admission, crises, stabilization, discharge), and intersections where EDDI directly or indirectly impacted communication and connection during the ICU journey.

CONCLUSION

Our findings highlight that diverse intersectional identities impact communication moments and relationship milestones during an ICU journey. To fully embrace a paradigm of PFCC, consideration should be given to creating an affirming and safe space for patients and their loved ones in the ICU.

Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families

PURPOSE

International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark.

METHODS

The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark.

RESULTS

The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care.

CONCLUSION

This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.

Palliative Care Utilization Among Non-Western Migrants in Europe: A Systematic Review

The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants.

Qualitative research on end-of-life communication with family carers in nursing homes: A discussion of methodological issues and challenges

Aim

To identify and summarize the challenges of conducting qualitative research exploring end-of-life communication between healthcare providers and bereaved family carers in nursing homes.

Design

A descriptive qualitative study based on in-the-field-notes and research diaries collected during a primary study involving 32 bereaved family carers and 14 nurses across 13 Italian nursing homes in 2018-2019.

Methods

Two trained female nurses conducted semi-structured, in-depth, open-ended interviews and recorded "in action" (i.e. reflections reported as in-the-field-notes) and "on action" (i.e. retrospective reflections within the team reported immediately in the research diaries) narratives, with the aim of identifying challenges encountered during the research process. A content analysis process was performed to analyse the narratives collected.

Results

We identified three major categories of challenges: (a) obtaining approval from the ethical committee; (b) approaching nursing homes and family carers; and (c) dealing with participant-related impairments (i.e. memory, emotional, physical).

Perceptions of care in patients from culturally and linguistically diverse background during acute and critical illness: A integrative literature review

OBJECTIVES

The aim of this review was to provide a synthesis of research on perceptions of safety and quality of care of patients from culturally and linguistically diverse backgrounds during acute and critical illness.

REVIEW METHOD USED

An integrative literature review based on the four-stage framework of Whittemore and Knafl was conducted including problem identification, a systematic literature search strategy, critical review of selected research articles, and integration of findings.

DATA SOURCES

Primary research articles published between January 2008 and October 2020 were identified from seven databases: PubMed, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, Medical Literature Analysis and Retrieval System Online (Medline), PsycINFO, the Cochrane Library, and Scopus electronic databases. The comprehensive search also included a manual search of citations and references from the selected articles.

REVIEW METHODS

Data extracted from studies included authors, year, country of origin, methodology and method, sample or participants, key findings, strengths, and limitations. The Critical Appraisal Skill Programme was used to evaluate the quality of studies.

RESULTS

Sixteen studies were included in the final analysis after critical appraisal. Four themes were identified: communication; the influence of culture, spirituality, and religion on care expectations; end-of-life care; and organisational structure, policy, and culture.

CONCLUSION

Research into patients from culturally and linguistically diverse backgrounds requiring care in acute and critical care areas is limited, in both the Australian and global context. There is an opportunity for future research in this area to inform the safety and quality of health care for this patient population and to enhance staff education and training programs.

Oncologists' Experience of Delivering Bad News in Korea

This study explored oncologists' experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists' perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient-physician relationships in communication of bad news.

State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: A mixed model study

This study aimed to determine whether family-centered multidisciplinary rounds could alleviate anxiety and uncertainty in illness and meet needs for critically ill patients’ families. A family-centered multidisciplinary rounds protocol was developed identifying needs of critically ill patients’ families, and family experiences were reviewed through in-depth interviews. A sequential mixed-methods study was utilized, combining survey data and semi-structured interviews in a tertiary medical intensive care unit in South Korea. A structured questionnaire assessed needs, anxiety, and uncertainty in illness for 50 participants. Interview data of 10 participants were analyzed using grounded theory. Assurance was the highest family need, followed by information need. Family needs differed according to gender, relationship to the patient, and length of intensive care unit stay. Participants reported family-centered multidisciplinary rounds provided a sense of relief, a chance to listen to medical staff, and a chance to provide medical staff with comprehensive information about patient care. Proximity needs were found to have a positive correlation with state anxiety, while comfort needs had a negative correlation with uncertainty in illness. Families reported family-centered multidisciplinary rounds were positive, useful experiences. Thus, standardization of family-centered multidisciplinary rounds is needed to meet families’ various needs.