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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 families.
Address conflicts among the clinical team prior to meeting with the
patient and/or family:
- 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 status.
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 (CQI) effort.
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.
- Listen.
- 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 options.
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.
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Promoting Excellence in End-of-Life Care is a national program of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.
