Families of critically ill hospital patients report higher satisfaction with clinician communication and a better perception of patient-centered care when the care team uses a low-cost strategy involving intensive emotional support and frequent meetings.
This study conducted by researchers of University of Pittsburgh School of Medicine is a randomized trial, it would be presented at the ATS 2018 International Conference in San Diego and scheduled for publication in the June issue of the New England Journal of Medicine.
The program is known as PARTNER (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building) also reduced patients' lengths of stay in intensive care units (ICUs) and lower hospitalization costs. During the trial, the program cost an average of $170 per patient, but it reduced hospitalization costs by 28%.
"One in five Americans die in or shortly after discharge from an ICU typically when a loved one decides to forego life-prolonging therapies. That difficult decision can be made unnecessarily stressful when there are problems with communication between a patient's family and their care team," said Douglas B. White, M.D., director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA).
Randomized Clinical Trial
PARTNER is delivered by the interprofessional team in the ICU, consisting of nurses, physicians, spiritual care providers, social workers and others who play a part in patient care. The program is overseen by nurse-leaders in each ICU who receive 12 hours of advanced communication skills training to support families.
The nurses meet with the families daily and arrange interdisciplinary clinician-family meetings within 48 hours of a patient coming to the ICU. A quality improvement specialist helps to incorporate the family support intervention into the clinicians' workflow.
To test its effectiveness, PARTNER was rolled out at five UPMC ICUs with different patient populations and staffing. It was implemented in a staggered fashion so that every participating ICU would eventually get PARTNER. Before receiving PARTNER, the ICUs continued their usual methods of supporting families of hospitalized patients.
A total of 1,420 adult patients were enrolled in the trial, and 1,106 of these patients' family members agreed to be a part of the study and its six-month follow-up surveys. The patients were very sick, with about 60% dying within six months of hospitalization and less than 1% living independently at home at that point.
Families who participated in the intervention were more likely to report that their loved one received patient-centered care where the patient's comfort, emotional well-being, beliefs and cultural needs were respected and guided clinical actions.
"We also observed a slightly higher rate of in-hospital mortality, which came with families reporting more patient-centered care and better communication," said White, who also holds the UPMC Chair for Ethics in Critical Care Medicine.
"This was likely because the intervention supported families in determining what goals of care were most respectful to the patient as a person in the setting of very advanced illness," said White.