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Communication About Chronic Critical Illness
Judith E. Nelson, MD, JD;
Alice F. Mercado, RN, MBA;
Sharon L. Camhi, MD;
Nidhi Tandon, MD;
Sylvan Wallenstein, PhD;
Gary I. August, BS;
R. Sean Morrison, MD
Arch Intern Med. 2007;167(22):2509-2515.
Background Despite poor outcomes, life-sustaining treatments including mechanical ventilation are continued for a large and growing population of patients with chronic critical illness. This may be owing in part to a lack of understanding resulting from inadequate communication between clinicians and patients and families. Our objective was to investigate the informational needs of patients with chronic critical illness and their families and the extent to which these needs are met.
Methods In this prospective observational study conducted at 5 adult intensive care units in a large, university-affiliated hospital in New York, New York, 100 patients with chronic critical illness (within 3-7 days of elective tracheotomy for prolonged mechanical ventilation) or surrogates for incapacitated patients were surveyed using an 18-item questionnaire addressing communication about chronic critical illness. Main outcome measures included ratings of importance and reports of whether information was received about questionnaire items.
Results Among 125 consecutive, eligible patients, 100 (80%) were enrolled; questionnaire respondents included 2 patients and 98 surrogates. For all items, more than 78% of respondents rated the information as important for decision making (>98% for 16 of 18 items). Respondents reported receiving no information for a mean (SD) of 9.0 (3.3) of 18 items, with 95% of respondents reporting not receiving information for approximately one-quarter of the items. Of the subjects rating the item as important, 77 of 96 (80%) and 69 of 74 (93%) reported receiving no information about expected functional status at hospital discharge and prognosis for 1-year survival, respectively.
Conclusions Many patients and their families may lack important information for decision making about continuation of treatment in the chronic phase of critical illness. Strategies for effective communication in this clinical context should be investigated and implemented.
Author Affiliations: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Nelson, Camhi, and Tandon, Ms Mercado, and Mr August), Brookdale Department of Geriatrics and Adult Development, Hertzberg Palliative Care Institute, (Drs Nelson and Morrison), and Department of Community Medicine (Dr Wallenstein), Mount Sinai School of Medicine, New York, New York.
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