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Published ahead of print on January 7, 2005, doi:10.1164/rccm.200409-1267OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 8, April 2005, 844-849

A more recent version of this article appeared on April 15, 2005
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Submitted on September 24, 2004
Accepted on January 3, 2005

Missed Opportunities during Family Conferences about End-of-life Care in the Intensive Care Unit

J. Randall Curtis1*, Ruth A Engelberg2, Marjorie D Wenrich3, Sarah E Shannon4, Patsy D Treece2, and Gordon D Rubenfeld2

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; Department of Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle, WA, USA, 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA, 3 School of Medicine, University of Washington, Seattle, WA, USA; Department of Medical Education and Biomedical Informatics, University of Washington, Seattle, WA, USA, 4 Department of Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: jrc{at}u.washington.edu.

Background: Improved communication with family members of critically ill patients can decrease the prolongation of dying in the ICU, but few data exist to guide the conduct of this communication. Objective: Our objective was to identify missed opportunities for physicians to provide support for family during family conferences. Methods: We identified ICU family conferences in 4 hospitals that included discussions about withdrawing life support or delivery of bad news. Fifty-one conferences were audiotaped including 214 family members. Thirty-six different physicians led the conferences as some physicians led more than one. We used qualitative methods to identify and categorize missed opportunities, defined as an occurrence when the physician had an opportunity to provide support or information to the family and did not. Main Results: Fifteen family conferences (29%) had missed opportunities identified. These fell into three categories: opportunities to listen and respond to family; opportunities to acknowledge and address emotions; and opportunities to pursue key tenets of palliative care, including exploration of patient preferences, explanation of surrogate decision-making, and affirmation of non-abandonment. The most common missed opportunities were those to listen and respond, but examples from the other categories suggest value in being aware of these opportunities. Conclusions: Identification of missed opportunities during ICU family conferences provides suggestions for improving communication during these conferences. Future studies are needed to determine whether addressing these opportunities will improve quality of care.
Key words: end-of-life care; communication; death; dying; critical care




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