Title : End of life decision making: Improving communication and satisfaction
This session covers communication strategies for end of life decision-making in the critically ill patient. Patients and families are often dissatisfied with communication and this leads to post intensive care syndrome for some families. This session will identify current literature, barriers to effective communication and different strategies to improve communication and hence satisfaction.
Five million patients are admitted annually to critical care settings with mortality as high as forty percent. Critically ill patients are often unable to make their own health care decisions leaving the family members to be surrogate decision makers, often involving end of life (EOL) choices. It becomes the healthcare provider’s responsibility to communicate effectively to the family members so decisions can be made based on knowledge, facts and patient beliefs. Unfortunately, healthcare providers are not prepared for these discussions and family members are at their highest level of stress and vulnerability during these difficult times.
Family members of critically ill patients have been dissatisfied with healthcare provider communication regarding treatment options and end of life decisions for decades. Family members report anxiety, stress and depressive symptoms long after the hospital course related to failed communication. Effective communication may affect the timeliness of decision-making in the dying patient as well as decreasing length of stay. Improving communication through the use of a standardized documentation tool and a consistent method of sharing information can assist in improving quality of care, specifically family satisfaction regarding EOL communication. Providing high quality healthcare involves all aspects of care, including EOL. The Institute of Medicine (IOM) supports the need for improvement in communication by providing a structured format. Nursing staff play a key role in the implementation of evidence-based guidelines to conduct a family meeting and improve overall outcomes. Although the focus of this project was a critical care setting the basic fundamental principles can be applied to any and all patient populations.