Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

Abstract

Purpose of review: Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU.

Recent findings: The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication.

Summary: We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.

Keywords: Comfort care; Communication; Goals of care; Palliative care.

Fig. 1

A graphical distribution of the use of the best case/worst case communication tool. Within a theoretical case of a young man with a severe traumatic brain injury. The tool is used to integrate all available clinical information and estimate the range of future outcomes. The circle represents the absolute best case outcome, while the square represents the absolute worst case outcome and the star represents the clinicians’ best judgment about what the future may bring. There is a clinical deterioration between day 2 and day 7, as manifested by the “most likely” scenario moving closer to the “worst case.” This is an original figure using the structure of Taylor et al. [69]