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A Study on End-of-Life Discussions in the ICU

July 18th, 2007  |  The Wind Beneath Our Wings: A Look at Nursing Research

icu

Improving communication in the intensive care unit reduces stress, anxiety and depression in family members.

My first reaction when I read this study, partially funded by the National Institute for Nursing Research, was a rather unprofessional “Duh!”. There isn’t an ICU nurse out there who would doubt this for a minute.

Then I started focusing on the details of the study, which can be found in the New England Journal of Medicine (February 1, 2007).

First the numbers: the study involved 126 patients in 22 different Intensive Care Units. The patients were between the ages of 56-80 and death was expected within days. The family members were predominantly female, average age of 54, 80% were either the spouse or the child of the patient and 60% of them were Catholic.

When the doctors believed that the patient would die in a few days, a family conference would be called, to discuss the continued use of life-saving measures. The “structure and conduct” of the conference and the effect on the family were being evaluated.

Fifty percent of the families had the “customary” conference.

The customary conference style would involve two family members, take approximately twenty minutes and during that time, the family would speak for about five minutes. The conference was led by the ICU attending and the patient’s nurse was present 60% of the time.

The other half of the study families participated in the interventional conference. In this group, “VALUE” guidelines were used (VALUE: value and acknowledge what the family says, listen, understand by asking questions and elicit questions from the family), three family members were present, the patient’s nurse participated in 81% of the conferences and a brochure on bereavement was given to the family. These conferences would last approximately 30 minutes and the family would speak about 13 minutes.

The results: all 126 conferences ended in the decision to forgo life-sustaining treatment.

However, more families were able to express their emotions in the intervention conferences (95% vs. 75%), more of those who disagreed with the decision to terminate life support were able to see it as the right decision at a later date if they participated in the interventional conference, and even up to three months later, the interventional group showed less symptoms of post traumatic stress disorder.

So in conclusion, the families who were given more time to ventilate, who felt that they were listened to, who had more family members present and more staff supporting them in the conference were better able to handle the stress and anxiety of having a loved one dying in an ICU and demonstrated less depression.

I would venture to say most nurses and physicians already knew these things instinctively, but putting them into practice was not always easy.

Here is evidence-based proof that families do deal with their anxiety, stress and depression better when the ICU staff listens to them and includes them in the decision-making process.

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Resource: National Institute Of Nursing Research. (2007, February 1). Improving communication in the ICU about end-of-life care in the ICU reduces symptoms of stress, anxiety and depression in family members. Retrieved July 17, 2007, from US Department of Health and Human Services, the National Institute of Health Web Site: http://www.nih.gov/news/pr/feb2007/ninr-01.htm

Photo credit: From the website of Doncaster and Bassetlaw Hospitals

Kim McAllister, RN
About Kim McAllister, RN
After 29 years as an RN, I decided I needed a change. So, I decided to keep working as an RN and blog now and then at emergiblog.com. Two years later, I'm blogging full time and actually went back to school for my BSN. I'm based out of the San Francisco Bay Area. After stints in Coronary Care, Intensive Care, Telemetry, Telephone Advice and Psychiatry, I found my niche in emergency nursing and have spent the last 16 years in that specialty. That's where I am today — full time blogger, emergency nurse and now columnist for Nursing Jobs.org!

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