only use for NUS 691 L

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End-of-Life Communication
WEEK 2

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OUTLINES
 Why it is important
 What happens in the ICU
 Good vs Bad communcation

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• EOL care in the ICU is significant in the U.S. health system
because 20% of Americans die shortly after ICU admissions
(Angus et al., 2004).
• The patients at the EOL in the ICU are vulnerable due to
cognitive and physical impairment, resulting in incapability
of making health care decision for themselves.
Why it is important

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• The features of EOL in the ICU includes: (1) Care is
provided and services are coordinated by an
interdisciplinary team (2) Patients, families, palliative and
non-palliative health care providers collaborate and
communicate about care needs (National Consensus
Project (2013).
What happens in the ICU

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• Good communication among clinicians, patients, and family
members is the most important factor in EOL care in the
ICU. However, the quality of communication for EOL care in
the ICU is still poor (Boyle et al., 2005).
Good EOL communication

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• Outcomes of poor end-of-life communication in ICUs
Bad communication
Patient outcomes Family outcomes Clinician outcomes
Unmet goals of
care
Unmet informational needs Conflict with family
members and among staff
Unmet preferences
for care
Lack of knowledge and
understanding
Stress
Lack of appropriate
palliation
Lack of shared decision making
Conflict with staff and among
family members
Lack of trust of clinicians
Stress
Anxiety
Depression
Uncertainty
Frustration
Long-term distress
Regret
Lingering doubt
Burden
Dissatisfaction
Anger
Frustration
Distancing
Depersonalization
Feeling drained
Avoidance of families
Powerlessness
Dissatisfaction
(National Consensus Project, 2013)

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References
Angus, D. C., Barnato, A. E., Linde-Zwirble, W. T., Weissfeld, L. A., Watson, R. S., Rickert, T., & Rubenfeld,
G. D. (2004). Use of intensive care at the end of life in the United States: an epidemiologic study.
Crit Care Med, 32(3), 638-643.
Boyle, D. K., Miller, P. A., & Forbes-Thompson, S. A. (2005). Communication and end-of-life care in the
intensive care unit: patient, family, and clinician outcomes. Crit Care Nurs Q, 28(4), 302-316.
National Consensus Project. (2013). Clinical Practice Guidelines for Quality Palliative Care. Available at:
https://www.hpna.org/multimedia/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf.
Accessed on March 21th, 2018.