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.