Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study

Abstract

Aims and objectives To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed. Background Improving end‐of‐life care requires a focus on adequate family–professionals prognostic communication, while maintaining a realistic level of hope and family support. Design A descriptive qualitative approach was applied. Methods Semi‐structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed. Results Two main categories emerged from the data of this study: ‘perspectives on optimistic hope’ and ‘approaches to prognostic communication’. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope. Conclusions Improving end‐of‐life care in intensive care units in Jordan requires a focus on family–professional communication. Jordanian intensive care doctors and nurses perceived honest family–professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication. Relevance to clinical practice Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences

“…Qualitative studies on physicians’ perceptions of communicating about end-of-life are practically non-existing. However, a recent study has shown that especially outside the Western Hemisphere, health care personnel may have difficulties providing a bad prognosis and hence avoid disclosing it [ 18 ]. It is also noteworthy that the majority of studies on POLST come from the USA.…”

Patterns of communicating care and caring in the intensive care unit

“…The nurses in ICU focus on patients and their families to prevent deterioration and improve the patient's condition (Sole et al, 2009), and to deal with life-saving interventions during acute physiological crises, with a particular focus on medical needs and access to technology (Marik, 2010). Good communication is vital to the assessment of symptoms and in promoting patients' participation in decision-making about treatment plans and end-of-life (EOL) decisions (Happ et al, 2004) and giving care to families at this stage (Almansour & Abdel Razeq, 2021;Rivera-Romero et al, 2019). There are various factors that affect communicating care and caring in ICU (Ganz, 2019;Happ et al, 2011).…”