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Communicating about end-of-life care with patients and families in the intensive care unit

      Because of the severity of illness of the patients, the intensive care unit (ICU) is a setting where death is common. Of patients who die in the hospital, approximately half are cared for in an ICU within 3 days of their death and one third spent at least 10 days in the ICU during their final hospitalization [
      The SUPPORT Principal Investigators
      A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT).
      ]. Many studies have shown that the majority of deaths in the ICU involve withholding or withdrawing multiple life-sustaining therapies [
      • Prendergast T.J
      • Luce J.M
      Increasing incidence of withholding and withdrawal of life support from the critically ill.
      ,
      • Faber-Langendoen K
      A multi-institutional study of care given to patients dying in hospitals. Ethical practices and implications.
      ,
      • Smedira N.G
      • Evans B.H
      • Grais L.S
      • Cohen N.H
      • Lo B
      • Cooke M
      • et al.
      Withholding and withdrawal of life support from the critically ill.
      ,
      • Vincent J.L
      • Parquier J.N
      • Preiser J.C
      • Brimioulle S
      • Kahn R.J
      Terminal events in the intensive care unit: review of 258 fatal cases in one year.
      ,
      • Eidelman L.A
      • Jakobson D.J
      • Pizov R
      • Geber D
      • Leibovitz L
      • Sprung C.L
      Foregoing life-sustaining treatment in an Israeli ICU.
      ,
      • Keenan S.P
      • Busche K.D
      • Chen L.M
      • McCarthy L
      • Inman K.J
      • Sibbald W.J
      A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support.
      ,
      • Koch K
      Changing patterns of terminal care management in an intensive care unit.
      ,
      • Vernon D.D
      • Dean J.M
      • Timmons O.D
      • Banner W
      • Allen W.E.M
      Modes of death in the pediatric intensive care unit: withdrawal and limitation of supportive care.
      ,
      • Youngner S.J
      • Lewandowski W
      • McClish D.K
      • Juknialis B.W
      • Coulton C
      • Bartlett E.T
      Do Not Resuscitate orders: incidence and implications in a medical intensive care unit.
      ,
      • Bedell S.E
      • Pelle D
      • Maher P.L
      • Cleary P.D
      Do Not Resuscitate orders for critically ill patients in the hospital: how are they used and what is their impact?.
      ]. Thus, the ICU represents a setting where decisions about managing the dying and death of patients are made on a frequent basis. These decisions involve communication among the critical care clinicians caring for the patient and the patient and his or her family and loved ones. Talking about end-of-life care can be difficult for clinicians in many settings, but may be especially difficult in the ICU because the culture and mission of the ICU is oriented to saving lives [
      • Caswell D
      • Omrey A
      The dying patient in the intensive care unit: making the critical difference.
      ,
      • Nelson J.E
      Saving lives and saving deaths.
      ]. Nonetheless, because a relatively large proportion of patients in the ICU die, providing high-quality end-of-life care to patients and their families is an important part of critical care. Therefore, all ICU clinicians need to learn effective communication skills to provide high-quality care to patients and their families.
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