Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):433-42. doi: 10.1016/j.genhosppsych.2010.04.007. Epub 2010 May 26.
Because one in five Americans die in the intensive care unit (ICU), the potential role of palliative care is considerable. End-of-life (EOL) communication is essential for the implementation of ICU palliative care. The objective of this review was to summarize current research and recommendations for ICU EOL communication.
For this qualitative, critical review, we searched PubMed, Embase, Cochrane, Ovid Medline, Cinahl and Psychinfo databases for ICU EOL communication clinical trials, systematic reviews, consensus statements and expert opinions. We also hand searched pertinent bibliographies and cross-referenced known EOL ICU communication researchers.
Family-centered communication is a key component of implementing EOL ICU palliative care. The main forum for this is the family meeting, which is an essential platform for implementing shared decision making, e.g., transitioning from curative to EOL palliative goals of care. Better communication can improve patient outcomes such as reducing psychological trauma symptoms, depression and anxiety; shortening ICU length of stay; and improving the quality of death and dying. Communication strategies for EOL discussions focus on addressing family emotions empathically and discussing death and dying in an open and meaningful way. Central to this is viewing ICU EOL palliative care and withdrawal of life-extending treatment as predictable and not an unexpected emergency.
Because the ICU is now a well-established site for death, ICU physicians should be trained with EOL communication skills so as to facilitate palliative care more hospitably in this challenging setting. Patient/family outcomes are important ways of measuring the quality of ICU palliative care and EOL communication.
由于五分之一的美国人在重症监护病房（ICU）死亡，因此姑息治疗的潜在作用是相当大的。临终（EOL）沟通对于实施 ICU 姑息治疗至关重要。本综述的目的是总结目前关于 ICU 临终沟通的研究和建议。
为了进行这项定性、批判性综述，我们在 PubMed、Embase、Cochrane、Ovid Medline、Cinahl 和 Psychinfo 数据库中搜索了 ICU 临终沟通临床试验、系统评价、共识声明和专家意见。我们还手动搜索了相关的参考文献，并交叉引用了已知的 EOL ICU 沟通研究人员。
以家庭为中心的沟通是实施 EOL ICU 姑息治疗的关键组成部分。这主要是通过家庭会议来实现的，家庭会议是实施共同决策的重要平台，例如，从治疗转向 EOL 姑息治疗目标。更好的沟通可以改善患者的预后，例如减轻心理创伤症状、抑郁和焦虑；缩短 ICU 住院时间；并提高死亡和临终的质量。EOL 讨论的沟通策略侧重于富有同理心地处理家庭情绪，并以开放和有意义的方式讨论死亡和临终。这其中的核心是将 ICU EOL 姑息治疗和停止延长生命的治疗视为可预测的，而不是意料之外的紧急情况。
由于 ICU 现在已经成为死亡的既定场所，因此应该对 ICU 医生进行 EOL 沟通技能培训，以便在这个充满挑战的环境中更友好地提供姑息治疗。患者/家庭的预后是衡量 ICU 姑息治疗和 EOL 沟通质量的重要方法。
