Improving Health Care Provider Communication in End-of-Life Decision-Making

Abstract

Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement.

A systematic review of the effects of advance care planning facilitators training programs

“…Focus group participants shared that it used to be hard to advocate for patients, but now they could act legitimately and felt ethically comfortable about ensuring EOL care.Smith, 2013 [25]To assess the feasibility and impact of a novel resident curriculum in EOL education to improve resident comfort with communication at EOLPre-test post-test design165 internal medicine residents in the USTwo one-hour lunch conference sessions on EOL communication with didactic slides and scripted role play, and six one-hour morning reports focusing on discussion of real-time casesElectronic survey with 24 questions related to demographics, previous requests for palliative care consultation, number of family meetings led, comfort with topics related to EOL care, behaviour during family meetings to discuss EOL care, and measures of self-efficacy for communicationThe curriculum impacted resident reports of comfort with specific topics in EOL care, including discussions of code status and comfort care. Small impact on resident reports of self-efficacy for communication was also shown.Wilson, 2017 [26]To improve staff and family satisfaction with EOL communication and to increase the level of knowledge and the confidence of providers in discussing EOL issues in ICU through the quality improvement projectPre-test post-test design21 critical care staff (12 registered nurses, 4 acute care nurse practitioners, 1 social worker, 2 palliative care team members, 1 member from the spiritual care team, and 1 care manager) in the USThe first intervention was an educational program dealing with EOL communication, which was completed along with introduction of the standardised family meeting tool. The second was implementation of the new meeting format with documentation of the meeting outcomes in a standardised chart form.1.…”

“…After the screening on the titles and abstracts, A total of 104 articles were potentially eligible and their full texts were retrieved and reviewed. Finally, ten articles were included in the review [17–26]. A PRISMA flow chart of the study retrieval and selection process with reasons for exclusion at each stage is provided in Fig.…”

“…The sample in each study varied from 16 to 278, with five [19, 20, 22, 24, 25] including more than 100 participants. Five studies were conducted in the US [17, 20, 22, 25, 26], two in Australia [19, 24], one in the UK [18], one in Canada [23] and one in Korea [21]. The majority of participants were nurses, physicians and medical students.…”

“…The majority of participants were nurses, physicians and medical students. The participants in three studies were recruited from hospitals [19, 23, 24], in three from internal medicine units [17, 18, 25] including renal medicine [18], in two from critical care units [21, 26] and in another two from students undergoing the usual medical curriculum [20, 22].…”

“…All included studies involved instructional sessions in their interventions [17–26], while the interventions in seven studies contained discussions among participants [17–20, 22, 23, 25], and four included role-play [17–19, 25]. Advanced technology, such as audio-visual materials [17, 19, 20, 22], online tutorials [23] and interactive patient e-simulation [19], were also used.…”