Stapleton Renee D, Engelberg Ruth A, Wenrich Marjorie D, Goss Christopher H, Curtis J Randall
Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
Crit Care Med. 2006 Jun;34(6):1679-85. doi: 10.1097/01.CCM.0000218409.58256.AA.
The quality of family-clinician communication in the intensive care unit is often inadequate, but little is known about specific clinician communication behaviors that might improve family satisfaction. In this exploratory analysis, we hypothesized that clinicians' communication behaviors providing emotional support to families during intensive care unit conferences would be associated with increased family satisfaction.
We audiotaped 51 intensive care unit family conferences in which withholding or withdrawing life support was discussed or bad news was delivered. Emotional support techniques used by clinicians during each conference were identified and coded using grounded theory.
Four Seattle hospitals.
Family members of critically ill patients.
Questionnaires rating satisfaction with communication were completed by 169 family members.
Linear regression with generalized estimating equation methods was used to analyze the association between the frequency of clinicians' emotionally supportive statements and family satisfaction. Increasing frequency of three types of clinicians' statements during family conferences was associated with increased family satisfaction: a) assurances that the patient will not be abandoned before death (p=.015); b) assurances that the patient will be comfortable and will not suffer (p=.029); and c) support for family's decisions about end- of-life care, including support for family's decision to withdraw or not to withdraw life-support (p=.005).
Most family members participating in this study were quite satisfied with the communication in the family conferences. Specific clinician communication behaviors are associated with increased family satisfaction during family conferences among family members who are willing to have a family conference recorded. Our results suggest that clinicians in the intensive care unit may improve the experiences of families of critically ill patients by providing explicit support for decisions made by a family with regard to end-of-life care and by assuring families continuity of high-quality care with particular attention to the patient's comfort.
重症监护病房中家庭与临床医生之间的沟通质量往往不尽人意，但对于可能提高家庭满意度的具体临床医生沟通行为却知之甚少。在这项探索性分析中，我们假设临床医生在重症监护病房会议期间为家属提供情感支持的沟通行为会与更高的家庭满意度相关。
我们对51次重症监护病房家庭会议进行了录音，这些会议讨论了维持或撤销生命支持措施或传达了坏消息。使用扎根理论确定并编码临床医生在每次会议期间使用的情感支持技巧。
西雅图的四家医院。
重症患者的家属。
169名家属完成了对沟通满意度进行评分的问卷。
采用广义估计方程法进行线性回归，以分析临床医生情感支持性陈述的频率与家庭满意度之间的关联。家庭会议期间临床医生三种类型陈述的频率增加与家庭满意度提高相关：a）保证患者在死亡前不会被放弃（p = 0.015）；b）保证患者会舒适且不会遭受痛苦（p = 0.029）；c）支持家属关于临终护理的决定，包括支持家属撤销或不撤销生命支持的决定（p = 0.005）。
参与本研究的大多数家属对家庭会议中的沟通相当满意。特定的临床医生沟通行为与愿意让家庭会议被录音的家属在家庭会议期间更高的家庭满意度相关。我们的结果表明，重症监护病房的临床医生可以通过明确支持家属关于临终护理的决定，并确保家属获得高质量护理的连续性，尤其关注患者的舒适度，来改善重症患者家属的体验。
