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. 2007 Dec 10;167(22):2509-15.
doi: 10.1001/archinte.167.22.2509.

Communication about chronic critical illness

Judith E Nelson  1 , Alice F Mercado, Sharon L Camhi, Nidhi Tandon, Sylvan Wallenstein, Gary I August, R Sean Morrison
Affiliations

Communication about chronic critical illness

Judith E Nelson et al. Arch Intern Med. .

Abstract

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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Figures

Figure
Figure
Distribution of items in Chronic Critical Illness 18-item questionnaire on which respondents (n = 100) reported receiving no information.
See this image and copyright information in PMC

References

    1. Nierman DM, Nelson JE, editors. Crit Care Clin. 3. Vol. 18. 2002. Chronic critical illness; pp. 461–715.
    1. Carson SS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care. 2006;12(5):405–411. - PubMed
    1. Camhi SL, Nelson JE. Chronic critical illness. In: Vincent JL, editor. Yearbook of Intensive Care Medicine. New York, NY: Springer; 2007. pp. 908–914.
    1. Nelson JE, Tandon N, Mercado A, Camhi SL, Ely EW, Morrison RS. Brain dysfunction: another burden for the chronically critically ill. Arch Intern Med. 2006;166(18):1993–1999. - PubMed
    1. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Crit Care Clin. 2002;18(3):461–476. - PubMed

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