Domain 2 - Communication within the Team & Patients/Families
Meet as an interdisciplinary team to discuss the patient’s condition, clarify goals of treatment and identify the patient’s and family’s needs and preferences:
- Develop an ICU policy which includes standards for communication with patients and families.
Address conflicts among the clinical team prior to meeting with the patient and/or family:
- Develop an EOLC critical pathway with checkboxes for communication items e.g., interdisciplinary team meetings and patient/family and clinician meetings (formal and informal).
Utilize expert clinical, ethical and spiritual consultants when appropriate:
- Develop methods to provide access to these consultants.
- Document offering families the opportunity to meet with these consultants.
- Document involvement of the consultants in care of the patient and family.
Recognize the adaptations in communication strategy required for patients and families according to the chronic versus acute nature of illness, cultural and spiritual differences and other influences:
- “Stage” the delivery of distressing news to patients and/or families.
- Involve spiritual and cultural experts or consultants in staff education and in care of patients and families.
Meet with the patient and/or family on a regular basis to review patient’s status and answer questions:
- Add communication category on preprinted physician’s and nurse’s narrative forms to cue clinician attention to communication.
- Allow sufficient time for meeting of patient and/or family with the health care team, particularly for the initial discussion of goals of care.
- Involve the attending physician in this initial meeting.
- Set up a schedule for future meetings with patient and/or family to review patient’s status.
Communicate all information to patients and families, including distressing news, in a clear, sensitive, unhurried manner and in an appropriate setting:
- Meet in a quiet private area with adequate seating.
- Introduce everyone who is present.
- Explain reason for meeting.
- Avoid euphemisms and medical jargon.
- Discuss the patient’s prognosis and realistic treatment goals frankly, but simultaneously demonstrate caring and empathy for the patient and family.
- Engage in informal de-briefing with team members following patient and/or family meetings to clarify understandings and solicit constructive feedback (e.g., “How do you think it went? What did I miss?”).
- Develop and send a Clinician Communication Evaluation survey to family three months after the patient’s death as part of an EOLC continuous quality improvement (CQI) effort.
Clarify the patient’s and family’s understanding of the patient’s condition and goals of care at the beginning and end of each meeting:
- Make eye contact.
- Listen.
- Acknowledge strong emotions.
- Ask if there are additional questions or concerns.
- Ask if there is any conflict within the family about the goals of care and treatment options.
Designate primary clinical liaison(s) who will communicate with the family daily:
- Ensure that the patient and/or family know who the primary clinical liaison(s) are and how to contact them.
Identify a family member who will serve as the contact person for the family:
- Document the primary contact and additional contacts in the medical record.
Prepare the patient and family for the dying process:
- Develop and distribute written material to help patients/and or families understand what to expect as death approaches.
- Emphasize the comfort care that will be given to the patient rather than the withholding and/or the withdrawal of life-sustaining treatment.
- Be explicit about symptom management strategies.
Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. |