Communicating with Patients' Families and Physicians About Prognosis and Goals of Care

Milic, Michelle; Puntillo, Kathleen; Turner, Kathleen; Joseph, Denah; Peters, Natalie; Ryan, Rio; Schuster, Cathy; Winfree, Holly; Cimino, Jenica; Anderson, Wendy G.

doi:10.4037/ajcc2015855

Cited by 44 publications

(65 citation statements)

References 23 publications

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“…Managing the tensions between recognising when survival is possible and when medical futility has been reached is challenging. Clinicians' perception of the value and relevance of a palliative approach for critically ill older patients largely determines the level and quality of end-of-life care provided in ICU (Milic et al, 2015). While much has been written about the elements of a "good death", this concept is rarely applied to older patients dying in ICU (Bailey et al, 2014).…”

Section: (P7)mentioning

confidence: 99%

“…Critically ill patients in ICU and their families are often not well informed about prognosis and goal of care (Milic et al, 2015). These gaps in end-of-life care may be related to:…”

Section: (P7)mentioning

confidence: 99%

“…Due to a number of patient, provider and health system factors, it is often challenging to ensure that dying ICU patients receive appropriate symptom management and end-of-life care (Milic et al, 2015). Critically ill patients in ICU and their families are often not well informed about prognosis and goal of care (Milic et al, 2015).…”

Section: (P7)mentioning

confidence: 99%

“…This approach allows the ICU team to palliate the patients' symptoms, seek concordance between treatment and dying patient's wishes by providing holistic care, decision making, communicating effectively and facilitating end-of-life care transitions (Cook andRocker, 2014, Nelson et al, 2010). ICU nurses have an important role in prognosis and goals of care at end-of life discussions with patients and their families and communicating with physicians about the needs of patients and family member (Milic et al, 2015). Following a determination that the older patient in the ICU is likely not going to survive, a discussion involving the patients, if they are able to participate, and their family is required to establish the new goals of care and to facilitate the transition to the patients' preferred place of care (Hunt et al, 2014).…”

Section: Palliative Care Approach Is Improving Quality Of End-of-lifementioning

confidence: 99%

See 3 more Smart Citations

Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

et al. 2016

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Section: (P7)mentioning

confidence: 99%

“…Critically ill patients in ICU and their families are often not well informed about prognosis and goal of care (Milic et al, 2015). These gaps in end-of-life care may be related to:…”

Section: (P7)mentioning

confidence: 99%

Section: (P7)mentioning

confidence: 99%

Section: Palliative Care Approach Is Improving Quality Of End-of-lifementioning

confidence: 99%

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Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

et al. 2016

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“…The survey was based on instruments developed for our needs assessment 18 and ICU nurse communication trainings. 21,25 Next was a survey designed by the authors that nurse leaders (n = 8) completed before and after the 3-day train-thetrainer session and at the end of the 2-year training, rating on Likert-type scales their skill level in key elements of small-group facilitation and role-playing for communication skills training. 33 Last, records were kept of the coaching rounds in the ICUs (1110 patients, Appendix 1), including information from patients' medical records about hospital length of stay, whether palliative care was consulted, and discharge disposition.…”

mentioning

confidence: 99%

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Anderson¹,

Puntillo²,

Cimino³

et al. 2017

Am J Crit Care

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Background Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care. Objective To implement and evaluate a palliative care professional development program for ICU bedside nurses. Methods From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds. Results Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them. Conclusions Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs. (American Journal of Critical Care. 2017; 26:361-371) by AACN on May 12, 2018 http://ajcc.aacnjournals.org/ Downloaded from P alliative care is a specialty and focus of care that aims to improve quality of care for patients who have serious and complex illnesses and their families. [1][2][3] Patients in intensive care units (ICUs) and their families have palliative care needs, including emotional support, management of pain and symptoms, and clinician-family communication to ensure that patients receive treatments that are consistent with their goals. [3][4][5][6][7][8][9][10][11][12][13] AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2017, Volume 26, No. 5 www.ajcconline.orgIn the ICU, palliative care is provided along with life-sustaining therapies and may be delivered by the ICU team (primary palliative care), a palliative care consult service (specialty palliative care), or both. 2,3,14 A number of barriers to integrating palliative care into the ICU have been identified, including inadequate training of clinicians and misperceptions that such treatment is the same as hospice, comfortfocused care, or end-of-life care. 3 Families, physicians, and nurses identify involvement of bedside nurses as a key factor in the quality of ICU palliative care. [15][16][17][18][19][20] Nurses' training and constancy at the bedside position them to identify palliative care needs, coordinate communication among families and an array of clinicians, and support and educate families. 15,16,19...

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Moral Distress Research Agenda

Pavlish

Robinson

Brown-Saltzman

et al. 2018

Moral Distress in the Health Professions

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Communicating with Patients' Families and Physicians About Prognosis and Goals of Care

Cited by 44 publications

References 23 publications

Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

Palliative Care Professional Development for Critical Care Nurses: A Multicenter Program

Moral Distress Research Agenda

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