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End-of-Life...missed opportunities by physicians
to provide information or support to family members
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 Journal of Respiratory
and Critical Care Medicine. |
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