HealthAugust 06, 2020

Navigating communication with patients' families in critical care

By: Melissa Welby, MD

Caring for critically ill patients comes with complex challenges, including communication with patients’ families.

If ever a time in history demonstrated the importance of communication with patients' families, it is the COVID-19 pandemic. The need to keep loved ones updated is nothing new, but before this disaster, it wasn't always as high a priority. Because of the unpredictability of COVID-19 and lack of family at the bedside, communication with critically ill patients and their families is more important than ever.

Coordinating with a patient's family can sometimes feel more stressful than the medical care itself, and many doctors feel unprepared to effectively deliver this difficult information to the patient and their support system. Michael J. Sise, MD, a surgeon and medical director of trauma education and research at the University of California, San Diego, School of Medicine, shares recommendations for improving communication with patients' families in his lecture "Communicating Effectively with the Family of a Critically Ill Patient," now available for CME credit through AudioDigest.

Effective communication in this setting takes practice and effort. At times, it can be viewed as a task that takes the physician away from their "real" job, but this communication is a crucial part of healing and recovery for the patient and their family. Families need to know their loved one is being cared for, and most patients want their support system involved.

3 tips for communication with patients' families

Many challenges can get in the way of efficient communication with patients' families in an acute care setting. The process of delivering life-and-death care can be fast-paced and unpredictable, consuming a physician's entire shift. Balancing these pressures with the need to carve out time for family communication can feel impossible. Here are three recommendations for how to do so.

1. Adapt to family dynamics

Emotions run high with families who are upset over a critically ill loved one. The stress of the situation can exacerbate already complicated family dynamics and further deteriorate relationships. These conflicts make communication with patients' families more challenging.

Because each family is different, there isn't one formula to apply to the discord. However, understanding these dynamics ahead of time can help you navigate "land mines" and increase your empathy for seemingly difficult family members.

Learn who is who in the family, including names, and make a mental note if any are healthcare professionals. If possible, inquire about family dynamics during the initial communication with critically ill patients. If they're unable to communicate, say to their emergency contact, "Tell me who's in the family and who will want to be involved in knowing about the patient's health. Are there particular conflicts between family members or challenges you can anticipate that we should be aware of?"

To listen to the full lecture, visit AudioDigest.

2. Schedule and streamline updates

It can be challenging for physicians to disseminate crucial information, but families become more stressed when they don't understand what's happening. Timely updates from the medical team are essential. With regular updates, the family becomes less anxious and begins to trust you, feeling reassured that they will be kept up to date. It can also help to set expectations about how and when you will communicate. Warn that emergencies may interfere with your ability to stick to a specific time.

Next, it's imperative to streamline communication between members of the medical team. Hearing conflicting reports undermines family members' trust in the care being provided. Even if the treatment is top-notch, most families don't understand medical intricacies and best practices, so any ill-informed statements can have long-lasting repercussions, including on the family's recovery from the potential death or loss of functioning of their loved one. People derive great comfort from knowing the team did everything they could.

Dr. Sise recommends treating family communication as a permanent item on the patient's active medical problem list. Sign it out to the next attending the same way you would the cardiopulmonary status and results of the latest blood cultures. Include details about which family member was spoken to, what was said, specific factors involved and what needs to be communicated during the next shift.

3. Communicate in context

Dr. Sise encourages physicians not to confuse the brief update delivered during rounds with a family meeting. A family meeting allows time for the family to process information and ask questions, while updates given at rounds leave little room for dialogue.

Communication must be tailored to meet the unique needs of the family. Deliver a complete picture of a patient's status using compassionate, easily comprehensible language. Let them know if parts of the status are uncertain while assuring them that upcoming test reports and consults will help make it clearer.

Hopes for the future

Working with critically ill patients brings complexities that extend beyond the medical treatment of the patient. Communication is a crucial part of care delivery, yet it can be an ongoing challenge for physicians. Dr. Sise's lecture can help physicians navigate this challenge.

While the pandemic has brought many stressful outcomes, one positive impact it may have could be an increased emphasis on the importance of communication with patients' families. This silver lining to the COVID-19 nightmare could profoundly improve the experience of families when their loved one is critically ill and facilitate ongoing healing for both the patient and their support system.

Melissa Welby, MD
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