PURPOSE: Medical decision-making in the ICU is complex and dynamic, especially with regards to end-of-life issues. Studies have noted many communication barriers, including provider discomfort with EOL discussions and provider uncertainty related to patient’s prognosis or patient’s wishes. Communication has been studied in the setting of family conferences. To date, communication during ICU rounds between medical staff has not been studied. The goal of this study is to evaluate the impact of a palliative care intervention on discussions about end-of-life issues in the daily clinical rounds.
METHODS: Intervention: The intervention consisted of adding a targeted discussion topic for Palliative Care into the current ongoing topic list usually covered in rounds. Design: Data was collected for 3 months prior to the intervention. Qualitative exploration of categories and themes was conducted. Future plans include a 3 months assessment following the implementation. Variables: Initial identification of categories and themes as determined by initial qualitative analysis, discussion and review. Procedures: After acquiring IRB approval and consent from all medical staff present during rounds, ICU rounds were recorded during a three-month period. Two physicians, an anthropologist, and a social psychologist reviewed the de-identified transcripts and audio recordings to identify themes, strategies and patterns related to discussions involving palliative care/end-of-life issues.
RESULTS: The following categories were established: 1) Direct reference to palliative care; 2) reference to patient’s perspectives, wishes and concerns (about any topic); 3) positive and negative statements of patient’s status; 4) references to futility; 5) statements of uncertainity (e.g. “I need some help here”; “I don’t understand what is happening”) and 6) references to goals of care. Inter-rater reliability was established.
CONCLUSION: Discussions between providers can be coded reliably into meaningful categories that are useful for future research. Palliative care discussions may influence medical management of patients.
CLINICAL IMPLICATIONS: By identifying associations between communication strategies, it may serve as a tool to address end-of-life issues on a routine and reliable basis that integrates good medical management with palliative care issues and patient / family preferences.
DISCLOSURE: Antonio Salud II, None.