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SAN FRANCISCO – Despite training recommendations, half of physicians and less than a third of nurses surveyed in adult intensive care units at 56 California hospitals reported receiving formal training in talking with patients and families about end-of-life.
A 2008 consensus statement by the American College of Critical Care Medicine included a recommendation for end-of-life communication skills training for clinicians to improve the care of patients dying in ICUs (Crit. Care Med. 2008;36:953-63).
Dr. Matthew H.R. Anstey and his associates approached 149 California hospitals to gauge the extent of implementation of this recommendation. At 56 hospitals, doctors and nurses who work in adult ICUs voluntarily completed an anonymous web-based survey. Eighty-four percent of the 1,363 respondents were nurses, he reported in a poster presentation at the Critical Care Congress, sponsored by the Society for Critical Care Medicine.
Overall, 32% of the respondents said they had received formal training in communication skills. A significantly higher percentage of doctors had undergone training (50%) compared with nurses (29%), said Dr. Anstey, who is currently a lecturer in anesthesia at Harvard Medical School, Boston.
Sixty-six percent of all respondents agreed that "nurses are present during the communication of end-of-life information to the family" at their institution. Nurses were significantly more likely to agree with this statement (69%) than were doctors (52%).
Both doctors and nurses were very supportive of the idea of formal communication training for ICU providers. When asked about possible strategies to reduce inappropriate care for ICU patients, 91% of respondents said communication training would have a positive effect, Dr. Anstey reported.
This could be accomplished by requiring ICU physicians to complete a communication training module for ongoing credentialing, he said in an interview. Either individual hospitals could require this as part of credentialing for privileges to work in the ICU, or state medical boards could require it, similar to the California Medical Board’s requirement that physicians obtain some continuing medical education in pain management, he suggested.
The characteristics of participating hospitals were similar to those of nonparticipating hospitals in the sizes of the hospitals and ICUs, their regional location in California, and the proportions of hospitals that are teaching facilities. The 93 nonparticipating hospitals were significantly more likely to be for-profit hospitals (59%) compared with participating hospitals (7%), and significantly less likely to be part of a hospital system containing more than three hospitals (54%) compared with participating hospitals (75%).
Dr. Anstey reported having no financial disclosures. His research was in conjunction with a Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice for which he was placed at Kaiser Permanente in California.
On Twitter @sherryboschert
I am not at all surprised, nor am I disappointed by these findings. As a nation we are headed in the right direction with improving communication around end-of-life (EOL) issues.
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One of the recommendations coming from 2008 guidelines by the American College of Physicians has to do with communicating advance directives and addressing the EOL topic with our patients. I am thrilled that we are beginning to have guidelines and recommendations like these to use as stimulation and leverage, improving the patient experience. If we reflect on some relatively depressing data from the last few years looking at internal medicine physicians at the University of California, San Francisco, admitting acutely ill patients and having advance directive discussions with them (J. Gen. Intern. Med. 2011;26:359-66), then I am encouraged by the findings in this ICU study. While the patient population (medical floor vs. ICU) is somewhat different, both populations benefit from advance care planning.
Barriers to end-of-life communications in ICUs include deficits in communication skills and a lack of time. The average amount of time, conservatively, is 45 minutes for these discussions. Care providers may avoid these discussions because of difficulty with their own emotions, perceiving the family as "difficult," a lack of understanding between the health care provider and the patient or family, and poor compliance. There’s little – if any – reimbursement, space is an issue as there are very few family conference rooms in hospitals, and there is mixed messaging by the numerous teams or specialties involved. The list goes on!
The Gundersen Health System in La Crosse, Wisc., is a good example of how to create a successful system of advance care planning. No one does it better. Also, the "premier programs" listed on the website of the Improving Palliative Care in the ICU (IPAL-ICU) Project are examples of leaders in the field.
Training in advance care planning is part of the education of students and residents at our institution. The University of Texas and Seton Healthcare jointly are creating a medical school in Austin. We plan to have all medical students spend time with our palliative care team and learn these communication skills. We began work on the IPAL-ICU program at two of our large hospitals. We also have put in a proposal to teach these skills to our providers and other providers within our community.
Finally, our program is collaborating with elderly advocacy groups in town to train their nurses and social workers in having upstream discussions with the population they serve so that decisions are addressed before hospitalization.
Dr. Stephen J. Bekanich, codirector of the palliative care program at Seton Healthcare, Austin, Tex., coauthors the Palliatively Speaking blog for Hospitalist News. He reported having no financial disclosures.
I am not at all surprised, nor am I disappointed by these findings. As a nation we are headed in the right direction with improving communication around end-of-life (EOL) issues.
|
|
One of the recommendations coming from 2008 guidelines by the American College of Physicians has to do with communicating advance directives and addressing the EOL topic with our patients. I am thrilled that we are beginning to have guidelines and recommendations like these to use as stimulation and leverage, improving the patient experience. If we reflect on some relatively depressing data from the last few years looking at internal medicine physicians at the University of California, San Francisco, admitting acutely ill patients and having advance directive discussions with them (J. Gen. Intern. Med. 2011;26:359-66), then I am encouraged by the findings in this ICU study. While the patient population (medical floor vs. ICU) is somewhat different, both populations benefit from advance care planning.
Barriers to end-of-life communications in ICUs include deficits in communication skills and a lack of time. The average amount of time, conservatively, is 45 minutes for these discussions. Care providers may avoid these discussions because of difficulty with their own emotions, perceiving the family as "difficult," a lack of understanding between the health care provider and the patient or family, and poor compliance. There’s little – if any – reimbursement, space is an issue as there are very few family conference rooms in hospitals, and there is mixed messaging by the numerous teams or specialties involved. The list goes on!
The Gundersen Health System in La Crosse, Wisc., is a good example of how to create a successful system of advance care planning. No one does it better. Also, the "premier programs" listed on the website of the Improving Palliative Care in the ICU (IPAL-ICU) Project are examples of leaders in the field.
Training in advance care planning is part of the education of students and residents at our institution. The University of Texas and Seton Healthcare jointly are creating a medical school in Austin. We plan to have all medical students spend time with our palliative care team and learn these communication skills. We began work on the IPAL-ICU program at two of our large hospitals. We also have put in a proposal to teach these skills to our providers and other providers within our community.
Finally, our program is collaborating with elderly advocacy groups in town to train their nurses and social workers in having upstream discussions with the population they serve so that decisions are addressed before hospitalization.
Dr. Stephen J. Bekanich, codirector of the palliative care program at Seton Healthcare, Austin, Tex., coauthors the Palliatively Speaking blog for Hospitalist News. He reported having no financial disclosures.
I am not at all surprised, nor am I disappointed by these findings. As a nation we are headed in the right direction with improving communication around end-of-life (EOL) issues.
|
|
One of the recommendations coming from 2008 guidelines by the American College of Physicians has to do with communicating advance directives and addressing the EOL topic with our patients. I am thrilled that we are beginning to have guidelines and recommendations like these to use as stimulation and leverage, improving the patient experience. If we reflect on some relatively depressing data from the last few years looking at internal medicine physicians at the University of California, San Francisco, admitting acutely ill patients and having advance directive discussions with them (J. Gen. Intern. Med. 2011;26:359-66), then I am encouraged by the findings in this ICU study. While the patient population (medical floor vs. ICU) is somewhat different, both populations benefit from advance care planning.
Barriers to end-of-life communications in ICUs include deficits in communication skills and a lack of time. The average amount of time, conservatively, is 45 minutes for these discussions. Care providers may avoid these discussions because of difficulty with their own emotions, perceiving the family as "difficult," a lack of understanding between the health care provider and the patient or family, and poor compliance. There’s little – if any – reimbursement, space is an issue as there are very few family conference rooms in hospitals, and there is mixed messaging by the numerous teams or specialties involved. The list goes on!
The Gundersen Health System in La Crosse, Wisc., is a good example of how to create a successful system of advance care planning. No one does it better. Also, the "premier programs" listed on the website of the Improving Palliative Care in the ICU (IPAL-ICU) Project are examples of leaders in the field.
Training in advance care planning is part of the education of students and residents at our institution. The University of Texas and Seton Healthcare jointly are creating a medical school in Austin. We plan to have all medical students spend time with our palliative care team and learn these communication skills. We began work on the IPAL-ICU program at two of our large hospitals. We also have put in a proposal to teach these skills to our providers and other providers within our community.
Finally, our program is collaborating with elderly advocacy groups in town to train their nurses and social workers in having upstream discussions with the population they serve so that decisions are addressed before hospitalization.
Dr. Stephen J. Bekanich, codirector of the palliative care program at Seton Healthcare, Austin, Tex., coauthors the Palliatively Speaking blog for Hospitalist News. He reported having no financial disclosures.
SAN FRANCISCO – Despite training recommendations, half of physicians and less than a third of nurses surveyed in adult intensive care units at 56 California hospitals reported receiving formal training in talking with patients and families about end-of-life.
A 2008 consensus statement by the American College of Critical Care Medicine included a recommendation for end-of-life communication skills training for clinicians to improve the care of patients dying in ICUs (Crit. Care Med. 2008;36:953-63).
Dr. Matthew H.R. Anstey and his associates approached 149 California hospitals to gauge the extent of implementation of this recommendation. At 56 hospitals, doctors and nurses who work in adult ICUs voluntarily completed an anonymous web-based survey. Eighty-four percent of the 1,363 respondents were nurses, he reported in a poster presentation at the Critical Care Congress, sponsored by the Society for Critical Care Medicine.
Overall, 32% of the respondents said they had received formal training in communication skills. A significantly higher percentage of doctors had undergone training (50%) compared with nurses (29%), said Dr. Anstey, who is currently a lecturer in anesthesia at Harvard Medical School, Boston.
Sixty-six percent of all respondents agreed that "nurses are present during the communication of end-of-life information to the family" at their institution. Nurses were significantly more likely to agree with this statement (69%) than were doctors (52%).
Both doctors and nurses were very supportive of the idea of formal communication training for ICU providers. When asked about possible strategies to reduce inappropriate care for ICU patients, 91% of respondents said communication training would have a positive effect, Dr. Anstey reported.
This could be accomplished by requiring ICU physicians to complete a communication training module for ongoing credentialing, he said in an interview. Either individual hospitals could require this as part of credentialing for privileges to work in the ICU, or state medical boards could require it, similar to the California Medical Board’s requirement that physicians obtain some continuing medical education in pain management, he suggested.
The characteristics of participating hospitals were similar to those of nonparticipating hospitals in the sizes of the hospitals and ICUs, their regional location in California, and the proportions of hospitals that are teaching facilities. The 93 nonparticipating hospitals were significantly more likely to be for-profit hospitals (59%) compared with participating hospitals (7%), and significantly less likely to be part of a hospital system containing more than three hospitals (54%) compared with participating hospitals (75%).
Dr. Anstey reported having no financial disclosures. His research was in conjunction with a Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice for which he was placed at Kaiser Permanente in California.
On Twitter @sherryboschert
SAN FRANCISCO – Despite training recommendations, half of physicians and less than a third of nurses surveyed in adult intensive care units at 56 California hospitals reported receiving formal training in talking with patients and families about end-of-life.
A 2008 consensus statement by the American College of Critical Care Medicine included a recommendation for end-of-life communication skills training for clinicians to improve the care of patients dying in ICUs (Crit. Care Med. 2008;36:953-63).
Dr. Matthew H.R. Anstey and his associates approached 149 California hospitals to gauge the extent of implementation of this recommendation. At 56 hospitals, doctors and nurses who work in adult ICUs voluntarily completed an anonymous web-based survey. Eighty-four percent of the 1,363 respondents were nurses, he reported in a poster presentation at the Critical Care Congress, sponsored by the Society for Critical Care Medicine.
Overall, 32% of the respondents said they had received formal training in communication skills. A significantly higher percentage of doctors had undergone training (50%) compared with nurses (29%), said Dr. Anstey, who is currently a lecturer in anesthesia at Harvard Medical School, Boston.
Sixty-six percent of all respondents agreed that "nurses are present during the communication of end-of-life information to the family" at their institution. Nurses were significantly more likely to agree with this statement (69%) than were doctors (52%).
Both doctors and nurses were very supportive of the idea of formal communication training for ICU providers. When asked about possible strategies to reduce inappropriate care for ICU patients, 91% of respondents said communication training would have a positive effect, Dr. Anstey reported.
This could be accomplished by requiring ICU physicians to complete a communication training module for ongoing credentialing, he said in an interview. Either individual hospitals could require this as part of credentialing for privileges to work in the ICU, or state medical boards could require it, similar to the California Medical Board’s requirement that physicians obtain some continuing medical education in pain management, he suggested.
The characteristics of participating hospitals were similar to those of nonparticipating hospitals in the sizes of the hospitals and ICUs, their regional location in California, and the proportions of hospitals that are teaching facilities. The 93 nonparticipating hospitals were significantly more likely to be for-profit hospitals (59%) compared with participating hospitals (7%), and significantly less likely to be part of a hospital system containing more than three hospitals (54%) compared with participating hospitals (75%).
Dr. Anstey reported having no financial disclosures. His research was in conjunction with a Commonwealth Fund Harkness Fellowship in Health Care Policy and Practice for which he was placed at Kaiser Permanente in California.
On Twitter @sherryboschert
AT THE CRITICAL CARE CONGRESS
