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Communication in the ICU to Be Strengthened

An intervention to improve communication between clinicians in the Intensive Care Unit (ICU) and family members of a dying patient significantly reduces feelings of stress,// anxiety, and depression in the family members, according to a study that appears in the February 1, 2007 issue of the New England Journal of Medicine.

The study, funded in part by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH), showed that this intervention also allows family members to express their emotions and arrive at a more realistic expectation of the outcome.

The researchers evaluated a set of communication guidelines for family conferences between ICU clinicians and family members. Based on earlier, extensive end-of-life research conducted by one of the collaborating researchers, Dr. J. Randall Curtis of the University of Washington, and funded by NINR, the guidelines followed the mnemonic VALUE: to Value what the family members said, Acknowledge their emotions, Listen, Understand the patient as a person through asking questions, and Elicit questions from the family members.

“Communication in these difficult situations is vital to all involved, including the patients, the family members, and the ICU physicians and nurses,” said Dr. Patricia Grady, the Director of NINR. “This research furthers our understanding of how clinicians can work with family members in the decision-making process and help them cope with the impending loss of a critically ill loved one.”

“I think this is a remarkable moment in end-of-life care,” said Dr. Curtis, “because this study shows that improving communication about end-of-life care in the ICU results in a dramatic reduction in symptoms” related to post-traumatic stress disorder in family members up to 3 months later.

Families of a patient near death in the ICU are often under great stress, and they rely on clinicians for information and support. A
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