Measures to evaluate clinician communication in the intensive care unit: A systematic review of measurement properties

Abstract

Objectives: Patients in the intensive care unit (ICU) face barriers to effective communication. Measures to evaluate communication quality remain limited. Patient and proxy reported outcome measures (PROMs and PrROMs) are increasingly being used to evaluate care in a patient-centered manner. We sought to identify validated PROMs and PrROMs for clinician communication quality in the ICU.

Methods: A systematic literature search was performed according to COSMIN guidelines. The search strategy included text words and subject headings related to communication (construct), ICU patients (population), and questionnaires or surveys (instrument). Studies were included if they focused on the development or measurement properties of a PROM or PrROM for clinician communication in the ICU, included adult patients or proxies, and were published in English after 2000. The results were imported to Covidence, a literature review citation screening tool and manager.

Results: 10258 studies were identified. After removal of duplicates, 6210 titles and abstracts were screened for inclusion. 29 full texts were assessed. Six manuscripts assessing three measures, the Family Satisfaction in the ICU (FS-ICU), Critical Care Family Satisfaction Survey (CCFSS), and the Family Inpatient Communication Survey (FICS), met criteria for inclusion. The only measure to have undergone an adequate design process, per COSMIN criteria, was the FICS. The FS-ICU and CCFSS demonstrated sufficient content validity. The FS-ICU demonstrated indeterminate content validity, insufficient structural validity, and sufficient construct validity. The FICS demonstrated sufficient structural validity, internal consistency, and construct validity. Other measurement properties were not reported.

Conclusions: None of the identified measures met criteria for recommendation based on the COSMIN framework. Furthermore, none of the measures exclusively or comprehensively assessed communication quality.

Practice implications: Proxy measures evaluating the quality of clinician communication in the ICU are limited. New measures or significant revision of current measures is necessary alongside developing multidimensional protocols for assessment.

Keywords: Communication; Intensive care; Outcome measures.