Chest
Original ResearchCritical Care MedicineEffectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients
Section snippets
Materials and Methods
A pre-post (before-after) design was used, and all patients meeting the eligibility criteria were enrolled consecutively. The control group (usual care) consisted of 135 patients and corresponding families enrolled from November 2005 to April 2006. We then implemented the intervention from May 2006 through February 2008, and enrolled 354 patients and family members. Institutional review board approvals from the two hospitals were obtained prior to study initiation.
Results
Figure 1 displays the sample enrollment, refusals, and dropouts, and Table 1 compares the experimental and control group on key clinical and demographic variables for patients as well as caregivers. There were significant differences between control and intervention groups (Table 1) on univariate analysis. Patients in the control group were older, more likely to have received care in the neuroscience ICU, less likely to have had treatment limitations in addition to a
Discussion
There is widespread agreement about the importance of skilled and sensitive communication with families of critically ill patients. Previous studies have focused on specific communicative techniques, such as active listening, use of emotionally supportive statements, and facilitation of shared decision making.26, 27, 28 The hypothesized mechanism of our intervention was that early and consistent communication that included explicit discussion of patient preferences, values, and goals would
Conclusions
The lack of the hypothesized effect of the intervention on the sample as a whole is strong evidence that the dynamics of decision making surrounding goals of care and aggressiveness of intervention are sufficiently complex that no single communication intervention is likely to have equivalent effects with all family members, in all environments. Directions for future research suggested by our findings include testing approaches that are tailored to family decision-making preferences and further
Acknowledgments
Author contributions: Dr Daly had full access to all data in the study and takes full responsibility for the integrity of all data and the accuracy of the data analysis.
Dr Daly: contributed to conceptualization of the project, all aspects of the conduct of the research, manuscript preparation, and approval of the final manuscript.
Dr Douglas: contributed to conceptualization of the project, all aspects of the conduct of the research, statistical analysis, manuscript preparation, and approval of
References (31)
Palliative care of the chronically critically ill patient
Crit Care Clin
(2002)- et al.
Family member satisfaction with end-of-life decision making in the ICU
Chest
(2008) - et al.
Trial of a disease management program to reduce hospital readmissions of the chronically critically ill
Chest
(2005) - et al.
Families' interactions with physicians in the intensive care unit: the impact on family's satisfaction
J Crit Care
(2008) - et al.
Impact of a proactive approach to improve end-of-life care in a medical ICU
Chest
(2003) - et al.
An intensive communication intervention for the critically ill
Am J Med
(2000) - et al.
The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults
Chest
(1991) The long-term outcomes of mechanical ventilation: what are they and how should they be used?
Respir Care
(2002)- et al.
Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery
Crit Care Med
(2008) - et al.
Brain dysfunction: another burden for the chronically critically ill
Arch Intern Med
(2006)
What are the needs of families of critically ill patients? A review of the literature since 1976
Heart Lung
Measuring the ability to meet family needs in an intensive care unit
Crit Care Med
Family satisfaction with care in the intensive care unit: results of a multiple center study
Crit Care Med
Survival and quality of life: short-term versus long-term ventilator patients
Crit Care Med
Composite outcomes in the chronically critically ill: survival, location, and cognitive status at four months
Am J Crit Care
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Funding/Support: This research was funded by the National Institute of Nursing Research, National Institutes of Health [Grant RO1NR008941].
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