积极倾听
医学
定性研究
多样性(控制论)
重症监护
内容分析
医学教育
护理部
心理学
计算机科学
心理治疗师
社会科学
社会学
人工智能
重症监护医学
作者
J. Randall Curtis,Ruth A. Engelberg,Marjorie D. Wenrich,Elizabeth Nielsen,Sarah E. Shannon,Patsy D. Treece,Mark R. Tonelli,Donald L. Patrick,Lynne Robins,Barbara Burns McGrath,Gordon D. Rubenfeld
标识
DOI:10.1053/jcrc.2002.35929
摘要
Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted.We identified family conferences in the ICUs of 4 Seattle-area hospitals. Conferences were eligible if the physician leading the conference believed that discussion about withholding or withdrawing life support or the delivery of bad news was likely to occur and if all conference participants consented to participate. Fifty conferences were audiotaped, transcribed, and analyzed by using the principles of grounded theory.We developed 2 frameworks for describing and understanding this communication. The first framework describes communication content, including introductions, information exchange, discussions of the future, and closings. The second framework describes communication styles and support provided to families and other clinicians and includes a variety of techniques such as active listening, acknowledging informational complexity and emotional difficulty of the situation, and supporting family decision making. These frameworks identify what physicians discuss, how they present and respond to issues, and how they support families during these conferences.This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.
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