Improving Communication with Families in the ICU Deborah Kasman MD, MA – Southern California: Baldwin Park Deborah.L.Kasman@kp.org RESEARCH TEAM: Hooman Mobassery MD – ICU Director Fran Izzo LCSW – Social Work Director Deborah Kasman MD, MA- Bioethics Director Michelle Martinez RN – ICU Nurse Jennifer Corado LCSW – ICU Social Worker Ayae Yamamoto MD - Statistician PURPOSE BACKGROUND RESULTS Improve communication with families in the ICU Improve communication between various providers in the ICU Promote consistency and continuity in communication with families in the ICU Decrease stress by improved support for providers working with distraught ICU families TRUST / UNCERTAINTY / MORAL DISTRESS Surrogate Stress Explore values, expectations & decision-making preferences Systemic approach to family meetings Systemic support for emotional needs of families Provider Stress Training to address uncertainty in prognosis Debriefs as appropriate Communication training for Providers Systems Issues Primary source (concierge) to support families & HC team Rapid response- Palliative Care teams Standardize comprehensive family approach FAMILY SATISFACTION ‘COMMUNICATION’ “1” is best; Likert scale 1 to 5 * P < 0.10 ** P < 0.05 FAMILY SATISFACTION “QUALITATIVE” More positive in Clinical Aspects Communication Sensitivity Friendly; Kind; Caring Supportive; Helpful Attentive; Comforting Professional; Polite; Joy Compassionate; Gentle; Love Stay Sweet; Great Attitude You Made it Bearable + Sensitivity Hurtful; Cruel Excluded; Upset; Scared Overwhelmed; Frustrated Lost respect; Smile more Don’t Ridicule or underestimate You make it Difficult - Sensitivity MEASUREMENTS Family Satisfaction in ICU Survey Pre N = 35 (36.8% return) Post N = 103 (41.0% return) Communication with ICU Family Survey Pre N = 23 (54.8% return) Post N = 26 (53.1% return) Physician Qualitative Questions Pre N = 6 of 7 Post N = 5 of 7 * DESIGNATED SOCIAL WORKER: Continuity & support for families in ICU Help assess family readiness for decision-making Support ICU providers with stressors P < 0.05 on one-tail t-test for “Honesty” and “Consistency” FAMILY SATISFACTION “SUPPORT” “5” is best score, Likert scale 1 to 5 “Surprise” results “At the end of the day people won't remember what you said or did they will remember how you made them feel” --Maya Angelou MD comment Pre: Different family members get fragmented information MD comment Post: There are fewer misunderstandings allowing a practitioner less familiar with family to gain insight INTERVENTION Designated SW* in ICU Education Sessions for MDs/RNs Coding Schema defines Family Needs level “C’” families having highest needs Family Meetings in < 72 hours of admit for level “C” families: Family Friendly Materials Intro to ICU pamphlet & Patient storyboard NURSES: DAY & NIGHT SHIFT Communication with Families in ICU Survey Items with greatest improvement in scores: P < 0.0001 CONCLUSIONS Communication with Families improved during the intervention First time families to ICU felt supported in the trial Return to ICU families felt less control & less included in care of their loved one Nurses in day & night shifts improved in all measures in survey Physicians felt improved support from SW, consistency in communication & better understanding of families Discuss goals of care in face of uncertainty Include ethnic/cultural aspects of care Team members aware of patient/family goals Improve Communication with Families Team interacts well making plan of care Values for decisions discussed openly & honestly Sum Score for “Current Work Situation” questions Improve Communication Between Providers Improved “titrating meds to control dyspnea” & “withdrawing life sustaining treatments” Information about dying & bereavement support Sum score for “Knowledge and Abilities” Promote Consistency & Continuity for Families Improved Support in “social work support/access” & “ethics consultation” & “resources to plan” Decrease Sum Score for “Contributing to Overall Stress” Decrease Stress for Providers through increased Support “Average of 3 questions” P< 0.05 Modifier Effect “Prior ICU experience” families felt less supported, & less control during the trial MD comment Pre: There is a disconnect between MD and patient understanding of the clinical situation MD comment Post: Conferences for “C” families had a big impact on communication/relationships with patients/families FUTURE PLANS Reproduce precise elements social worker added to ICU care team Build trust with ‘Prior ICU experience’ families & include them in care of loved one Nurses to design strategies to enhance family-centered ICU care Prepare families for uncertain clinical course -- include palliative care earlier