A study in 4 intensive care units (ICUs) aimed at family conferences to discuss the withholding or withdrawing of life-sustaining therapy in critically ill patients showed that in 15 of 51 conferences physicians missed opportunities to provide either support or information to the family. All 51 family conferences were audio-taped with permission from the family. Along with family members, they involved 226 clinicians, including 36 physicians who led the conferences; 50 nurses; 25 social workers; and 12 chaplains, priests, or nuns. The conferences ranged in length from 7 to 74 minutes, with the average lasting about 32 minutes.
According to the investigators, the majority of deaths that occur in the intensive care unit in North America involve withholding or withdrawing life-sustaining therapy. When this occurs, most patients are unable to communicate for themselves, so decision-making is delegated to family members and clinicians. In this setting, say the researchers, communication with the family is complicated by the fact that family members report significant financial and health burdens as a result of their loved one's critical illness, as well as a major load of anxiety and depression.
The missed opportunities to communicate fell into three categories: opportunities to listen and respond to the family; to acknowledge and address emotions; and to pursue key principles of medical ethics and palliative care, including explanations of patient preferences, surrogate decision-making, and affirmation of non-abandonment. They said that the most common missed opportunity occurred when clinicians failed to listen and respond appropriately and directly to comments made by family members. Sometimes, the doctors involved answered a different question than that posed by the family member. The study appears in the second issue for April 2005 of the American Thoracic Society's peer-reviewed American Jou
Contact: Cathy Carlomagno
American Thoracic Society