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

被引:67
作者
Curtis, J. Randall [1 ,4 ]
Ciechanowski, Paul S. [2 ]
Downey, Lois [1 ]
Gold, Julia [3 ]
Nielsen, Elizabeth L. [1 ]
Shannon, Sarah E. [4 ]
Treece, Patsy D. [1 ]
Young, Jessica P. [1 ]
Engelberg, Ruth A. [1 ]
机构
[1] Univ Washington, Div Pulm & Crit Care, Harborview Med Ctr, Dept Med, Seattle, WA 98104 USA
[2] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA 98104 USA
[3] Univ Washington, Sch Law, Seattle, WA 98104 USA
[4] Univ Washington, Sch Nursing, Dept Biobehav Nursing & Hlth Syst, Seattle, WA 98104 USA
关键词
Communication; Palliative care; Critical care; Randomized trial; OF-LIFE CARE; POSTTRAUMATIC-STRESS-DISORDER; GENERALIZED ANXIETY DISORDER; INTENSIVE-CARE; COLLABORATIVE CARE; PALLIATIVE CARE; SELF-EFFICACY; ETHICS CONSULTATIONS; PRACTICE GUIDELINES; PROACTIVE APPROACH;
D O I
10.1016/j.cct.2012.06.010
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
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. We developed a multi-faceted, interprofessional intervention based on self-efficacy theory. The intervention involves a "communication facilitator" - a nurse or social worker - trained to facilitate communication among the interprofessional ICU team and with the critically ill patient's family. The facilitators are trained using three specific content areas: a) evidence-based approaches to improving clinician-family communication in the ICU, b) attachment theory allowing clinicians to adapt communication to meet individual family member's communication needs, and c) mediation to facilitate identification and resolution of conflict including clinician-family, clinician-clinician, and intra-family conflict. The outcomes assessed in this randomized trial focus on psychological distress among family members including anxiety, depression, and post-traumatic stress disorder at 3 and 6 months after the ICU stay. This manuscript also reports some of the lessons that we have learned early in this study. (C) 2012 Elsevier Inc. All rights reserved.
引用
收藏
页码:1245 / 1254
页数:10
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