Because of the complexity of both the medical and social situations of patients and long stays in hospital intensive care units (ICUs), gaps in communication, misunderstandings and a lack of consensus between families and health care providers about goals of care are frequent, and therefore, escalating costs, adding to the stress of difficult situations. And, on occasion, strained relationships can develop between families and the health care team.

"Disagreements not only occur between professionals and families, but also within the health care team," said lead investigator Barbara J. Daly, associate professor of nursing at Case and clinical ethics director at University Hospitals of Cleveland. "What is needed is a simple yet comprehensive communication system that addresses decision-making with CCI patients."

That's why Daly and her research team are designing and testing a system that will address family decision-making with CCI patients, as well as provide the families comfort and support. The study implements an intensive communication system for the family of CCI patients on patient and family outcomes and resource use in ICUs of varying specialties.

Daly's team is training the doctors, nurse practitioners and other medical professionals in the intervention program, including raising the topics to be covered in each meeting, establishing goals, identifying clinical milestones and setting the timing for re-evaluation of the patient's condition.

"The whole team has to ask themselves the question, 'What outcome would this person find acceptable?' If we can do a better job of being clear and consistent as a health care team, we can be more supportive of families facing these important, life-altering decisions."; Source: Case Western Reserve University