Feb 2, 2016
What is the problem?
Delivering bad news and having an end of life conversation are core
skills for any practitioner who deals with critically ill patients.
Current data show that while 22% of deaths in the USA now occur in
ICU, 54% of families surveyed have a poor understanding of
patient’s diagnosis, treatment plan and prognosis. Dr. Kate Granger
found this out first hand while admitted to hospital in the UK and
started the #hellomynameis campaign.
What is the evidence?
While families feel more validated if given longer to speak,
doctors speak for 71% of the time in family meetings. -Longer
meetings are also associated with greater patient and family member
satisfaction. -Patients perceive that doctors spend longer with
them if the doctor is sitting down. -Use of a simple mnemonic
increases satisfaction and reduced the incidence of PTSD in family
members.
What do experts do?
1. Prepare for the meeting. Decide who will attend, what you will
talk about and what your goals are.
2. Introduce everyone and explain the agenda.
3. Gather everyone’s understanding
4. Listen and don’t interrupt
5. Empathise (physicians express no empathy in 1/3 of family
meetings)
6. Make the patient’s voice heard
7. Make your recommendation to go forward
8. Reflect on the meeting after it concludes
What about the difficult situations?
Hope is an issue that comes up often. Many other specialties
emphasise the importance of hope, while intensivists are often seen
as being nihilistic. But we can still foster a degree of hope in
patients and families without being unrealistic. -Techniques for
managing conflict are discussed such as identifying discord in the
family and avoiding mixed messages from staff. -The importance of
spirituality is discussed.