Communication About Chronic Critical Illness
Open accessAbstract
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.
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Clinicians often fail to adequately elicit patient treatment preferences, provide guidance about the surrogate's role, disclose likely long-term outcomes, and discuss the option of comfort-focused care.
“clinicians often fail to adequately elicit patient treatment preferences, provide guidance about the surrogate’s role, disclose likely long-term outcomes, and discuss the option of comfort-focused care (7–13).”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [8]
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- Authors
- Nelson, J. E.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Nelson, Judith E.
- ORCID
- Nelson, Judith E.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2007-12-10
- Volume
- 167
- Issue
- 22
- Pages
- 2509
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3157319
- OpenAlex
- W2164388803
- Cited by
- 157
- References
- 48
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 11 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 11 · 2018: 9 · 2017: 18 · 2016: 8 · 2015: 11 · 2014: 6 · 2013: 6 · 2012: 9
- FWCI
- 9.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k02ag024476-02)
- National Institute on Aging (K02-AG024476)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- chronic critical illness, patient-family communication, information needs, prolonged mechanical ventilation, tracheotomy, surrogate decision-making, prognosis disclosure, life-sustaining treatment, intensive care unit, end-of-life decisions
- MeSH terms
- Adult, Aged, Aged, 80 and over, Chronic Disease, Communication, Decision Making, Female, Follow-Up Studies, Humans, Male, Middle Aged, New York, Physician-Patient Relations, Prospective Studies, Surveys and Questionnaires, Truth Disclosure, Incidence, Survival Rate, Critical Illness
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