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Goals of care conferences for incapacitated ICU patients
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.
Background: Previous studies suggest that clinicians and surrogates rarely discuss patient values in ICU family conferences about goals of care despite recommendations from international critical care societies.
Study design: Analysis of audiotaped goals of care conferences.
Setting: ICUs in six U.S. academic centers.
Synopsis: The authors analyzed 249 audiotaped family conferences concerning goals of care for severely critically ill, incapacitated patients with acute respiratory distress syndrome and found that information about patient values and preferences was discussed in only 68.4% of the conferences.
Moreover, there was no deliberation about how to apply patient values and preferences to clinical decisions in 55.7% of the conferences. Surrogates were more likely to bring up these elements of shared decision making than were physicians.
Bottom line: Care providers and surrogates of critically ill ICU patients often fail to discuss patient preferences, values, and how they apply to care decisions in goals of care conferences.
Citation: Scheunemann LP et al. Clinician-family communication about patients’ values and preferences in intensive care units. JAMA Intern Med. 2019;179(5):676-84.
Dr. Mastalerz is a hospitalist and medical director of 9A Accountable Care Unit at the Colorado Health Foundation.