Difficult Decisions

Study shows complicated nature of families' decision-making process for loved ones in ICUs

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When severely ill patients are admitted to medical intensive care units, their families have to make difficult decisions.

In order to assist such families through the decision-making process, clinical staff in many ICUs conduct a new technique of communication intervention covering relevant topics.

According to recent research from Case Western Reserve University, this new intervention communication system is less beneficial than previously thought. A previous study conducted by one Boston hospital showed positive results for the intervention system. However, in addition to using a small sample set, that study analyzed the intervention system only within the context of a medical ICU. The Case Western researchers found that within the context of surgical and neurological ICUs, the intervention communication system did not prove more effective than normal procedures.

The Case Western team also found that the intervention has different results for different individuals, and that the vast majority of the communication process neglects the personal and emotional stresses of the situation.

By 2020, an estimated 600,000 patients annually will enter an ICU. Consequently, clinicians and researchers are seeking more effective methods to aid families through the decision-making process.

In order to see if the intervention alters patients' length of stay in the ICU, researchers compared the effects of the communication system in 346 patients to normal procedure in 135 patients. The intervention process began with a half hour meeting five days after a patient requiring a ventilator was admitted to the ICU. The half hour meetings with families - which cover the subjects of medical updates, preferences and goals for the patient, treatment plans, prognosis, and markers of patient improvement - continued once a week until the patients were moved out of the ICU to a different hospital ward, to another facility, to their homes, or because of death.

Barbara Daly and Sara Douglas, lead researchers of the study from the Frances Payne Bolton School of Nursing at Case Western Reserve, found no significant difference between the intervention group and the normal procedure group in length of stay in the ICU. They also found varying results of the communication system for different types of ICU patients because of their different needs.

Daly notes that her team's research shows the need for better communication with the families of ICU patients. Clinicians should take a closer look into the particular wants and needs of different ICU patients and their families in order to improve the communication process.

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Review Date: 
January 5, 2011
Last Updated:
January 6, 2011