Facilitating communication for critically ill patients and their family members: Study protocol for two randomized trials implemented in the U.S. and France.

Background: Critically-ill patients and their families suffer a high burden of psychological symptoms due, in part, to many transitions among clinicians and settings during and after critical illness, resulting in fragmented care. Communication facilitators may help.

Design And Intervention: We are conducting two cluster-randomized trials, one in the U.

Identifying Goals of Care Conversations in the Electronic Health Record Using Natural Language Processing and Machine Learning.

Context: Goals-of-care discussions are an important quality metric in palliative care. However, goals-of-care discussions are often documented as free text in diverse locations. It is difficult to identify these discussions in the electronic health record (EHR) efficiently.

Effect of a Patient and Clinician Communication-Priming Intervention on Patient-Reported Goals-of-Care Discussions Between Patients With Serious Illness and Clinicians: A Randomized Clinical Trial.

Importance: Clinician communication about goals of care is associated with improved patient outcomes and reduced intensity of end-of-life care, but it is unclear whether interventions can improve this communication.

Objective: To evaluate the efficacy of a patient-specific preconversation communication-priming intervention (Jumpstart-Tips) targeting both patients and clinicians and designed to increase goals-of-care conversations compared with usual care.

Design, Setting, And Participants: Multicenter cluster-randomized trial in outpatient clinics with physicians or nurse practitioners and patients with serious illness.

Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

Context: Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire.

Objectives: To understand factors that facilitate end-of-life care discussions that guide interventions to improve care.

Methods: We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions.

Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care.

Background: Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve.

Objective: Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU).

Methods: This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008).

Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions.

Background: Discussions about withdrawal of life-sustaining therapies often include family members of critically ill patients. These conversations should address essential components of the dying process, including expected time to death after withdrawal.

Objectives: The study objective was to aid physician communication about the dying process by identifying predictors of time to death after terminal withdrawal of mechanical ventilation.

Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care.

Rationale: Communication with family of critically ill patients is often poor and associated with family distress.

Objectives: To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care.

Methods: We conducted a randomized trial at two hospitals.

Hospital variation and temporal trends in palliative and end-of-life care in the ICU.

Objectives: Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented.

Design/setting: Retrospective cohort study of consecutive patients dying in the ICU in 13 Seattle-Tacoma-area hospitals between 2003 and 2008.

Development and evaluation of an interprofessional communication intervention to improve family outcomes in the ICU.

The intensive care unit (ICU), where death is common and even survivors of an ICU stay face the risk of long-term morbidity and re-admissions to the ICU, represents an important setting for improving communication about palliative and end-of-life care. Communication about the goals of care in this setting should be a high priority since studies suggest that the current quality of ICU communication is often poor and is associated with psychological distress among family members of critically ill patients. This paper describes the development and evaluation of an intervention designed to improve the quality of care in the ICU by improving communication among the ICU team and with family members of critically ill patients.

The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU.

Background: There is conflicting evidence about the influence of race/ethnicity on the use of intensive care at the end of life, and little is known about the influence of socioeconomic status.

Methods: We examined patients who died in the ICU in 15 hospitals. Race/ethnicity was assessed as white and nonwhite.

Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial.

Rationale: Because of high mortality, end-of-life care is an important component of intensive care.

Objectives: We evaluated the effectiveness of a quality-improvement intervention to improve intensive care unit (ICU) end-of-life care.

Methods: We conducted a cluster-randomized trial randomizing 12 hospitals.

Integrating palliative and critical care: evaluation of a quality-improvement intervention.

Rationale: Palliative care in the intensive care unit (ICU) is an important focus for quality improvement.

Objectives: To evaluate the effectiveness of a multi-faceted quality improvement intervention to improve palliative care in the ICU.

Methods: We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU.

Communication in the intensive care unit about the end of life.

Communicating well in the intensive care unit is essential to providing quality critical care for the families of patients who are expected to die. There are many examples in the literature of how clinicians fall short of meeting these needs of families. There is also a developing body of literature describing approaches and tools that may have a positive impact on the perceived quality of end-of-life communication.

Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup.

For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill.

Integrating palliative and critical care: description of an intervention.

A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care.

Communication about end-of-life care between language-discordant patients and clinicians: insights from medical interpreters.

Background: Communication about health care and especially end-of-life care is difficult for clinicians and patients when they do not speak the same language. Our purpose was to improve understanding of how to approach discussions between language-discordant patients and clinicians about terminal or life-threatening illness.

Methods: We conducted a qualitative study with 4 focus groups with 43 professional medical interpreters.

Missed opportunities during family conferences about end-of-life care in the intensive care unit.

Background: Improved communication with family members of critically ill patients can decrease the prolongation of dying in the intensive care unit (ICU), but few data exist to guide the conduct of this communication.

Objective: Our objective was to identify missed opportunities for physicians to provide support for or information to family during family conferences.

Methods: We identified ICU family conferences in four hospitals that included discussions about withdrawing life support or delivery of bad news.

Factors associated with nurse assessment of the quality of dying and death in the intensive care unit.

Objective: To determine the feasibility of using nurse ratings of quality of dying and death to assess quality of end-of-life care in the intensive care unit and to determine factors associated with nurse assessment of the quality of dying and death for patients dying in the intensive care unit.

Design: Prospective cohort study.

Setting: Hospital intensive care unit.

Narcotic and benzodiazepine use after withdrawal of life support: association with time to death?

Objective: To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU.

Design: Retrospective chart review.

Setting: University-affiliated, level I trauma center.

Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction.

Objective: Family members of critically ill patients report dissatisfaction with family-clinician communication about withdrawing life support, yet limited data exist to guide clinicians in this communication. The hypothesis of this analysis was that increased proportion of family speech during ICU family conferences would be associated with increased family satisfaction.

Design: Cross-sectional study.

Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit.

Objective: The intensive care unit remains a setting where death is common, and a large proportion of these deaths are preceded by withdrawal of life support. We describe a quality improvement project implementing and evaluating a "withdrawal of life support order form" to improve quality of end-of-life care in the intensive care unit.

Design: Before-after evaluation.

Studying communication about end-of-life care during the ICU family conference: development of a framework.

Purpose: Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted.

Methods: We identified family conferences in the ICUs of 4 Seattle-area hospitals.