Clinician statements and family satisfaction with family conferences in the intensive care unit
Clinician statements and family satisfaction with family conferences in the intensive care unit
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DOI：
10.1097/01.ccm.0000218409.58256.aa
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发表时间：
2006-06-01
影响因子：
8.8
通讯作者：
Curtis, J. Randall
中科院分区：
文献类型：
--
作者：
Stapleton, Renee D.;Engelberg, Ruth A.;Curtis, J. Randall
目标。在重症监护病房的家庭-临床医生沟通的质量往往是不足的，但很少知道具体的临床医生沟通行为，可能提高家庭满意度。在本探索性分析中，我们假设临床医生在重症监护病房会议期间为家庭提供情感支持的沟通行为与家庭满意度的增加有关。设计：我们对51个重症监护病房的家庭会议进行录音，其中讨论了保留或撤回生命支持或传达了坏消息。临床医生在每次会议中使用的情感支持技术被识别并使用扎根理论进行编码。四家西雅图医院实验对象危重病人家属。干预措施：对169名家庭成员进行沟通满意度问卷调查。测量结果和主要结果：采用广义估计方程法进行线性回归分析临床医生情绪支持陈述频率与家庭满意度的关系。三种类型的临床医生在家庭会议上的陈述频率增加与家庭满意度增加有关：a)保证患者在死前不会被遗弃（p = 0.015）；B)保证病人舒适，不会受苦（p =.029）；c)支持家庭关于临终关怀的决定，包括支持家庭决定撤回或不撤回生命维持系统（p = 0.005）。结论：参与本研究的大多数家庭成员对家庭会议中的沟通感到满意。在愿意记录家庭会议的家庭成员中，特定的临床医生沟通行为与家庭会议期间家庭满意度的增加有关。我们的研究结果表明，重症监护病房的临床医生可以通过为家庭做出的关于临终关怀的决定提供明确的支持，并通过确保家庭持续的高质量护理，特别关注患者的舒适度，来改善危重患者家庭的体验。
Objectives. The quality of family-clinician communication in the intensive care unit is often inadequate, but little is known about specific clinician communication behaviors that might improve family satisfaction. In this exploratory analysis, we hypothesized that clinicians' communication behaviors providing emotional support to families during intensive care unit conferences would be associated with increased family satisfaction.Design: We audiotaped 51 intensive care unit family conferences in which withholding or withdrawing life support was discussed or bad news was delivered. Emotional support techniques used by clinicians during each conference were identified and coded using grounded theory.Setting. Four Seattle hospitals.Subjects. Family members of critically ill patients.Interventions: Questionnaires rating satisfaction with communication were completed by 169 family members.Measurements and Main Results: Linear regression with generalized estimating equation methods was used to analyze the association between the frequency of clinicians' emotionally supportive statements and family satisfaction. Increasing frequency of three types of clinicians' statements during family conferences was associated with increased family satisfaction: a) assurances that the patient will not be abandoned before death (p =.015); b) assurances that the patient will be comfortable and will not suffer (p =.029); and c) support for family's decisions about end-of-life care, including support for family's decision to withdraw or not to withdraw life-support (p =.005).Conclusions: Most family members participating in this study were quite satisfied with the communication in the family conferences. Specific clinician communication behaviors are associated with increased family satisfaction during family conferences among family members who are willing to have a family conference recorded. Our results suggest that clinicians in the intensive care unit may improve the experiences of families of critically ill patients by providing explicit support for decisions made by a family with regard to end-of-life care and by assuring families continuity of high-quality care with particular attention to the patient's comfort.