1
|
Kentish-Barnes N, Azoulay E, Reignier J, Cariou A, Lafarge A, Huet O, Gargadennec T, Renault A, Souppart V, Clavier P, Dilosquer F, Leroux L, Légé S, Renet A, Brumback LC, Engelberg RA, Pochard F, Resche-Rigon M, Curtis JR. A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients. Intensive Care Med 2024; 50:712-724. [PMID: 38573403 DOI: 10.1007/s00134-024-07390-y] [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: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden. METHODS We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E). RESULTS 385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1-3] vs 2 [1-4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (- 0.48; 1.55)]. There were no significant differences in secondary outcomes. CONCLUSION This study does not support the use of facilitators for family members of ICU patients.
Collapse
Affiliation(s)
- Nancy Kentish-Barnes
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France.
| | - Elie Azoulay
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
- Paris Cité University, Paris, France
| | - Jean Reignier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
- Université de Nantes, Nantes, France
| | - Alain Cariou
- Paris Cité University, Paris, France
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Antoine Lafarge
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Olivier Huet
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
- Université de Brest, Brest, France
| | - Thomas Gargadennec
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
| | - Anne Renault
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Pamela Clavier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
| | | | - Ludivine Leroux
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Sébastien Légé
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Anne Renet
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Lyndia C Brumback
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Frédéric Pochard
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Matthieu Resche-Rigon
- Paris Cité University, Paris, France
- Clinical Research Unit, APHP, Saint Louis University Hospital, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| |
Collapse
|
2
|
Curtis JR, Lee RY, Brumback LC, Kross EK, Downey L, Torrence J, Heywood J, LeDuc N, Mallon Andrews K, Im J, Weiner BJ, Khandelwal N, Abedini NC, Engelberg RA. Improving communication about goals of care for hospitalized patients with serious illness: Study protocol for two complementary randomized trials. Contemp Clin Trials 2022; 120:106879. [PMID: 35963531 PMCID: PMC10042145 DOI: 10.1016/j.cct.2022.106879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although goals-of-care discussions are important for high-quality palliative care, this communication is often lacking for hospitalized older patients with serious illness. Electronic health records (EHR) provide an opportunity to identify patients who might benefit from these discussions and promote their occurrence, yet prior interventions using the EHR for this purpose are limited. We designed two complementary yet independent randomized trials to examine effectiveness of a communication-priming intervention (Jumpstart) for hospitalized older adults with serious illness. METHODS We report the protocol for these 2 randomized trials. Trial 1 has two arms, usual care and a clinician-facing Jumpstart, and is a pragmatic trial assessing outcomes with the EHR only (n = 2000). Trial 2 has three arms: usual care, clinician-facing Jumpstart, and clinician- and patient-facing (bi-directional) Jumpstart (n = 600). We hypothesize the clinician-facing Jumpstart will improve outcomes over usual care and the bi-directional Jumpstart will improve outcomes over the clinician-facing Jumpstart and usual care. We use a hybrid effectiveness-implementation design to examine implementation barriers and facilitators. OUTCOMES For both trials, the primary outcome is EHR documentation of a goals-of-care discussion within 30 days of randomization; additional outcomes include intensity of end-of-life care. Trial 2 also examines patient- or family-reported outcomes assessed by surveys targeting 3-5 days and 4-8 weeks after randomization including quality of goals-of-care communication, receipt of goal-concordant care, and psychological symptoms. CONCLUSIONS This novel study incorporates two complementary randomized trials and a hybrid effectiveness-implementation approach to improve the quality and value of care for hospitalized older adults with serious illness. CLINICAL TRIALS REGISTRATION STUDY00007031-A and STUDY00007031-B.
Collapse
Affiliation(s)
- J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America.
| | - Robert Y Lee
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lyndia C Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lois Downey
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Janaki Torrence
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Joanna Heywood
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Nicole LeDuc
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Kasey Mallon Andrews
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Jennifer Im
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America; Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Nita Khandelwal
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States of America
| | - Nauzley C Abedini
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
3
|
Schwartz AC, Dunn SE, Simon HFM, Velasquez A, Garner D, Tran DQ, Kaslow NJ. Making Family-Centered Care for Adults in the ICU a Reality. Front Psychiatry 2022; 13:837708. [PMID: 35401268 PMCID: PMC8987300 DOI: 10.3389/fpsyt.2022.837708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.
Collapse
Affiliation(s)
- Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah E Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Hannah F M Simon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alvaro Velasquez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David Garner
- Department of Nursing, Grady Health System, Atlanta, GA, United States
| | - Duc Quang Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
4
|
Edward KL, Galletti A, Huynh M. Enhancing Communication With Family Members in the Intensive Care Unit: A Mixed-Methods Study. Crit Care Nurse 2020; 40:23-32. [DOI: 10.4037/ccn2020595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background
Nurses in the intensive care unit are central to clinical care delivery and are often the staff members most accessible to family members for communication. Family members’ ratings of satisfaction with the intensive care unit admission are affected more by communication quality than by the level of care for the patient. Family members may feel that communication in the intensive care unit is inconsistent.
Objectives
To use a shared decision-making model to deliver a communication education program for intensive care unit nurses, evaluate the confidence levels of nurses who undertook the education, and examine changes in family members’ satisfaction with communication from intensive care unit nurses after the nurses received the education.
Methods
A mixed-methods design was used. Seventeen nurses and 81 family members participated.
Results
Staff members were overall very confident with communicating with family members of critically ill patients. This finding was likely linked to staff members’ experience in the position, with 88% of nurses having more than 11 years’ experience. Family members were happy with care but dissatisfied with the environment.
Conclusions
Environmental factors can negatively affect communication with family members in the intensive care unit.
Collapse
Affiliation(s)
- Karen-leigh Edward
- Karen-leigh Edward is an adjunct professor of nursing and practice-based research, Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Swinburne University, Hawthorn, Australia
| | - Alessandra Galletti
- Alessandra Galletti is a research associate, Swinburne University of Technology
| | - Minh Huynh
- Minh Huynh is a lecturer, Sports Analytics & Data Science, School of Allied Health, Human Services & Sport, College of Science, Health and Engineering, Latrobe University, Bundoora, Melbourne, Australia
| |
Collapse
|
5
|
Validation and Analysis of the European Quality Questionnaire in Italian Language. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238852. [PMID: 33260777 PMCID: PMC7729862 DOI: 10.3390/ijerph17238852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 01/28/2023]
Abstract
The European Quality Questionnaire (euroQ2) is the culturally-adapted version to the European context of the Family Satisfaction in Intensive Care Unit (FS-ICU) and Quality of Dying and Death (QODD) tools in a single instrument divided into three parts (the last is optional). These tools were created for an adult setting. The aim of this study was the Italian validation and analysis of the euroQ2 tool. The Italian version of euroQ2 questionnaire was administered to the relatives, over 18 years of age, of adult intensive care unit patients, with the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale—Revised (IES-r). For the re-test phase the questionnaire was administered a second time. One hundred questionnaires were filled in. The agreement between test and retest was between 17–19 out of 20 participants with an upward trend in the re-test phase. A measure of coherence and cohesion between the euroQ2 variables was given by Cronbach’s alpha: in the first part of the questionnaire alpha was 0.82, in the second part it was 0.89. The linear Pearson’s correlation coefficients between all questions showed a weak positive correlation. The results obtained agreed with the original study. This study showed a good stability of the answers, an indication of an unambiguous understanding of the Italian translation.
Collapse
|
6
|
Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
Collapse
Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Van Keer RL, Deschepper R, Huyghens L, Bilsen J. Preventing Conflicts Between Nurses and Families of a Multi-ethnic Patient Population During Critical Medical Situations in a Hospital. J Transcult Nurs 2019; 31:250-256. [DOI: 10.1177/1043659619859049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Little is known about how to avoid intercultural nurse–family conflicts in critical care settings. In this article, strategies are discussed that may be useful to prevent or mitigate intercultural nurse–family conflicts during critical medical situations in hospital. Method: Strategies are based on an ethnographic study by Van Keer et al., other literature, and expert opinion. Results: Sufficient structural measures are needed. First, institutions must create appropriate ward policies, such as including nurses in end-of-life communication. Second, nurses should be coached in the workplace. Third, institutions must provide adapted, visual, ward information to families. Additionally, education and research are needed. These measures should be actively stimulated by nurse managers and reflect a multicultural program supported by the hospital. Discussion: Intercultural nurse–family conflict prevention or mitigation should take into account organizational aspects, on hospital units and in hospital as a whole, and the crucial role of education and research.
Collapse
Affiliation(s)
| | | | - Luc Huyghens
- Vrije Universiteit Brussel, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | |
Collapse
|
8
|
Azoulay E, Forel JM, Vinatier I, Truillet R, Renault A, Valade S, Jaber S, Durand-Gasselin J, Schwebel C, Georges H, Merceron S, Cariou A, Moussa M, Hraiech S, Argaud L, Leone M, Curtis JR, Kentish-Barnes N, Jouve E, Papazian L. Questions to improve family-staff communication in the ICU: a randomized controlled trial. Intensive Care Med 2018; 44:1879-1887. [PMID: 30374690 DOI: 10.1007/s00134-018-5423-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/17/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Relatives of intensive care unit (ICU) patients suffer emotional distress that impairs their ability to acquire the information they need from the staff. We sought to evaluate whether providing relatives with a list of important questions was associated with better comprehension on day 5. METHODS Randomized, parallel-group trial. Relatives of mechanically ventilated patients were included from 14 hospitals belonging to the FAMIREA study group in France. A validated list of 21 questions was handed to the relatives immediately after randomization. The primary endpoint was comprehension on day 5. Secondary endpoints were satisfaction (Critical Care Family Needs Inventory, CCFNI) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS). RESULTS Of 394 randomized relatives, 302 underwent the day-5 assessment of all outcomes. Day-5 family comprehension was adequate in 68 (44.2%) and 75 (50.7%) intervention and control group relatives (P = 0.30), respectively. Over the first five ICU days, median number of family-staff meetings/patient was 6 [3-9], median total meeting time was 72.5 [35-110] min, and relatives asked a median of 20 [8-33] questions including 11 [6-13] from the list, with no between-group difference. Satisfaction and anxiety/depression symptoms were not significantly different between groups. The only variable significantly associated with better day-5 comprehension by multivariable analysis was a higher total number of questions asked before day 5. CONCLUSIONS Providing relatives with a list of questions did not improve day-5 comprehension, secondary endpoints, or information time. Further research is needed to help families obtain the information they need. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02410538.
Collapse
Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | | | - Isabelle Vinatier
- Surgical ICUs From Montpellier or Marseille Hospitals, Medical-Surgical ICUs From La Roche sur Yon, La Roche sur Yon, France
| | - Romain Truillet
- Statistical Department of Marseille, AP-HM, Marseille, France
| | | | - Sandrine Valade
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Samir Jaber
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | | | | | | | | | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France
| | | | | | | | - Marc Leone
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Elisabeth Jouve
- Statistical Department of Marseille, AP-HM, Marseille, France
| | | |
Collapse
|
9
|
Richards CA, Starks H, O'Connor MR, Bourget E, Lindhorst T, Hays R, Doorenbos AZ. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? Am J Hosp Palliat Care 2017; 35:840-846. [PMID: 29179572 DOI: 10.1177/1049909117739853] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. OBJECTIVE To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. METHODS Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. RESULTS We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. CONCLUSIONS Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.
Collapse
Affiliation(s)
- Claire A Richards
- 1 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,2 Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Helene Starks
- 1 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,3 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - M Rebecca O'Connor
- 6 Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA
| | - Erica Bourget
- 7 Department of Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Taryn Lindhorst
- 8 School of Social Work, University of Washington, Seattle, WA, USA
| | - Ross Hays
- 3 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA.,4 Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA.,10 Palliative Care Program, Seattle Children's Hospital, Seattle, WA, USA.,11 The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,12 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Ardith Z Doorenbos
- 4 Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA.,5 Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.,12 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.,13 Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Grady PA. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science. Heart Lung 2016; 46:3-6. [PMID: 27612388 DOI: 10.1016/j.hrtlng.2016.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/28/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022]
Abstract
Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations.
Collapse
|
11
|
|