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
- Address conflicts among the clinical team prior to meeting with the patient and/or
- 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
- 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
- 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.
- 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
- 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.