Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Crit Care. 2019 Jun;51:6-12. doi: 10.1016/j.jcrc.2019.01.011. Epub 2019 Jan 14.
Intensive care unit (ICU) physicians should provide relatives of critically ill patients with appropriate and clear information, regarding prognosis, treatment options and expectations.
To assess whether a structured communication tool improves satisfaction with care and engenders realistic expectations among relatives of critically ill patients.
A controlled, pre-post intervention design was implemented in the General and Medical ICUs in the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Forty relatives of patients who received usual communication from the medical staff (control group) were interviewed. We then implemented a structured communication tool and another forty family members were interviewed (intervention group). The ICU physicians who participated in the family meeting were also interviewed.
Satisfaction in the intervention group was higher regarding ease of obtaining the information (90% vs 70%, p = .025) and the consistency of information provided (92.5% vs 77.5%, p = .057). There was better correlation between physicians' and relatives' expectations in the intervention group regarding hospital survival (Kappa 0.322 vs 0.054, p = .01). Physicians predicted more accurately patients' actual hospital survival.
A structured communication tool was associated with improved family satisfaction with communication and expectations regarding hospital survival. Further research is required to evaluate this promising intervention.
重症监护病房（ICU）的医生应该向病危患者的家属提供关于预后、治疗选择和期望的适当和明确的信息。
评估结构化沟通工具是否能提高危重病患者家属对护理的满意度并产生现实的期望。
在以色列耶路撒冷的哈达萨-希伯来大学医学中心的普通和内科重症监护病房实施了一项对照、干预前后的设计。
对接受医护人员常规沟通的 40 名患者家属（对照组）进行了访谈。然后，我们实施了结构化沟通工具，对另外 40 名家属进行了访谈（干预组）。参与家庭会议的 ICU 医生也接受了访谈。
干预组在获取信息的难易程度（90%对 70%，p=0.025）和提供信息的一致性（92.5%对 77.5%，p=0.057）方面的满意度更高。在干预组中，医生和家属对住院存活率的期望之间存在更好的相关性（kappa 0.322 对 0.054，p=0.01）。医生更准确地预测了患者的实际住院存活率。
结构化沟通工具与提高家庭对沟通的满意度以及对住院存活率的期望有关。需要进一步的研究来评估这一有前途的干预措施。
