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ICU communication study reveals complexities of family decision-making
Date:1/5/2011

have spent more than five days on a mechanical ventilator.

For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.

Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.

"The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. "We took the study into real-life situations."

Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.

In the medical units, the patients generally are older and chronically illmany suffering several chronic illnesses. The other ICUs generally serve younger patients who are more likely to have suffered a sudden acute health crisis, such as an emergency surgery or trauma from a motor vehicle accident.

Daly said many treatments in the medical ICU will not sustain life, and families face complicated end-of-life decisions to stop or continue ineffective treatments.

The research group also tracked conversational interchanges between family members and doctors.

All families received medical updates. About 86% of the meetings covered treatment plans; 94%, prognosis; 78 percent, preferences and goals; and only 68%, milestones.

Daly said analyses of the types of conversations found that 98% of the time was spent relaying facts about the patient, and only 2% was spent on personal, emotional,
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Contact: Susan Griffith
susan.griffith@case.edu
216-368-1004
Case Western Reserve University
Source:Eurekalert

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