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Topics in Practice Management |

Practical Guidance for Evidence-Based ICU Family Conferences

J. Randall Curtis, MD, MPH, FCCP; Douglas B. White, MD, MA
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Dr. Curtis), Harborview Medical Center, University of Washington, Seattle, WA; and Division of Pulmonary and Critical Care Medicine (Dr. White), University of California at San Francisco, San Francisco, CA.

Correspondence to: J. Randall Curtis, MD, MPH, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, University of Washington, 325 Ninth Ave, Seattle, WA 98104-2499; e-mail: jrc@u.washington.edu


For editorial comment see page 676

Funding was provided by the National Institute of Nursing Research (R01NR-05226). Dr. White is supported by an National Institutes of Health Career Development Award (KL2RR024130).

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(4):835-843. doi:10.1378/chest.08-0235
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Because most critically ill patients lack decision-making capacity, physicians often ask family members to act as surrogates for the patient in discussions about the goals of care. Therefore, clinician-family communication is a central component of medical decision making in the ICU, and the quality of this communication has direct bearing on decisions made regarding care for critically ill patients. In addition, studies suggest that clinician-family communication can also have profound effects on the experiences and long-term mental health of family members. The purpose of this narrative review is to provide a context and rationale for improving the quality of communication with family members and to provide practical, evidence-based guidance on how to conduct this communication in the ICU setting. We emphasize the importance of discussing prognosis effectively, the key role of the integrated interdisciplinary team in this communication, and the importance of assessing spiritual needs and addressing barriers that can be raised by cross-cultural communication. We also discuss the potential value of protocols to encourage communication and the potential role of quality improvement for enhancing communication with family members. Last, we review issues regarding physician reimbursement for communication with family members within the context of the US health-care system. Communication with family members in the ICU setting is complex, and high-quality communication requires training and collaboration of a well-functioning interdisciplinary team. This communication also requires a balance between adhering to processes of care that are associated with improved outcomes and individualizing communication to the unique needs of the family.

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