Family-centered end-of-life care in the ICU.

Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process.

[1]  G. Rubenfeld,et al.  Missed opportunities during family conferences about end-of-life care in the intensive care unit. , 2005, American journal of respiratory and critical care medicine.

[2]  Jennifer Kryworuchko,et al.  A Qualitative Study of Family Involvement in Decisions About Life Support in the Intensive Care Unit , 2012, The American journal of hospice & palliative care.

[3]  Mary Beth Happ,et al.  Nurses' perceptions of communication training in the ICU. , 2012, Intensive & critical care nursing.

[4]  S. Livigni,et al.  A narrative-based study on communication by family members in intensive care unit. , 2013, Journal of critical care.

[5]  P. Marik Management of the critically ill geriatric patient , 2006, Critical care medicine.

[6]  T. Morita,et al.  Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus. , 2003, Journal of pain and symptom management.

[7]  V. Tilden,et al.  Family Decision Making in Foregoing Life-Extending Treatments , 1999 .

[8]  D. Wiegand Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: interactions between patients' families, healthcare providers, and the healthcare system. , 2006, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[9]  B. Bowers,et al.  Working toward consensus: providers' strategies to shift patients from curative to palliative treatment choices. , 2001, Research in nursing & health.

[10]  E. Ely,et al.  Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients* , 2010, Critical care medicine.

[11]  M. Mitchell,et al.  Positive effects of a nursing intervention on family-centered care in adult critical care. , 2009, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[12]  D. Cook,et al.  Dying in the ICU: perspectives of family members. , 2003, Chest.

[13]  L. Petri,et al.  Is a good death possible after withdrawal of life-sustaining therapy? , 2010, The Nursing clinics of North America.

[14]  D. Wiegand In their own time: the family experience during the process of withdrawal of life-sustaining therapy. , 2008, Journal of palliative medicine.

[15]  D. White,et al.  Practical guidance for evidence-based ICU family conferences. , 2008, Chest.

[16]  Joseph Varon,et al.  Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. , 2003, The New England journal of medicine.

[17]  M. Antonelli,et al.  Challenges in end-of-life care in the ICU , 2004, Intensive Care Medicine.

[18]  P. Butow,et al.  www.mja.com.au Supplement , 2007 .

[19]  G. Rubenfeld,et al.  Narcotic and benzodiazepine use after withdrawal of life support: association with time to death? , 2004, Chest.

[20]  J. Luce,et al.  Increasing incidence of withholding and withdrawal of life support from the critically ill. , 1997, American journal of respiratory and critical care medicine.

[21]  G. Bernard,et al.  Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). , 2001, JAMA.

[22]  D C Angus,et al.  Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? , 2000, JAMA.

[23]  K. Dracup,et al.  Symptom experiences of family members of intensive care unit patients at high risk for dying , 2010, Critical care medicine.

[24]  Laura M. Curtis,et al.  Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults , 2013, Journal of the American Geriatrics Society.

[25]  K. Haley,et al.  Intensive communication: Four-year follow-up from a clinical practice study , 2003, Critical care medicine.

[26]  R. Hopkins,et al.  Long-term neurocognitive function after critical illness. , 2006, Chest.

[27]  E. Bigler,et al.  Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. , 1999, American journal of respiratory and critical care medicine.

[28]  D. Wiegand,et al.  End-of-life care in the critical care unit for patients with heart failure. , 2008, Critical care nurse.

[29]  V. Tilden,et al.  Decisions about life-sustaining treatment. Impact of physicians' behaviors on the family. , 1995, Archives of internal medicine.

[30]  M. Balas,et al.  Assessing and managing critically ill older adults: Resources for educators and clinicians. , 2010, Journal of gerontological nursing.

[31]  R. Mularski,et al.  Quality of dying in the ICU: ratings by family members. , 2005, Chest.

[32]  J. Curtis,et al.  Expressions of nonabandonment during the intensive care unit family conference. , 2005, Journal of palliative medicine.

[33]  N. Christakis,et al.  Preparing for the end of life: preferences of patients, families, physicians, and other care providers. , 2001, Journal of pain and symptom management.

[34]  J. le Gall,et al.  Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity , 2001, Critical care medicine.

[35]  V. Tilden,et al.  Family decision-making to withdraw life-sustaining treatments from hospitalized patients. , 2001, Nursing research.

[36]  S. Gilbertson-White,et al.  Documentation on withdrawal of life support in adult patients in the intensive care unit. , 2004, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[37]  D. Jacob,et al.  Family members' experiences with decision making for incompetent patients in the ICU: a qualitative study. , 1998, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[38]  G. Rubenfeld,et al.  Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction* , 2004, Critical care medicine.

[39]  E. Arias,et al.  Deaths: final data for 2000. , 2002, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[40]  B. Lo,et al.  Hope, Truth, and Preparing for Death: Perspectives of Surrogate Decision Makers , 2008, Annals of Internal Medicine.

[41]  B. Engström,et al.  Relatives' involvement in nursing care: a qualitative study describing critical care nurses' experiences. , 2011, Intensive & critical care nursing.

[42]  G. Elwyn,et al.  Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study , 2011, Journal of evaluation in clinical practice.

[43]  S. Mayer,et al.  Withdrawal of life support in the neurological intensive care unit , 1999, Neurology.

[44]  J. Curtis,et al.  Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication. , 2008, Chest.

[45]  É. Azoulay,et al.  End-of-life family conferences: Rooted in the evidence , 2006, Critical care medicine.

[46]  C. Sprung,et al.  End-of-life practices in 282 intensive care units: data from the SAPS 3 database , 2009, Intensive Care Medicine.

[47]  M. Pisani,et al.  Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients , 2003, Journal of the American Geriatrics Society.

[48]  Juliana Barr,et al.  Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005 , 2007, Critical care medicine.

[49]  Amber E Barnato,et al.  Use of intensive care at the end of life in the United States: An epidemiologic study* , 2004, Critical care medicine.

[50]  J. Davidson Family-centered care: meeting the needs of patients' families and helping families adapt to critical illness. , 2009, Critical care nurse.

[51]  V. Tilden,et al.  Life support withdrawal: communication and conflict. , 2003, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[52]  S. Pendharkar,et al.  Management and Outcomes of Pulmonary Mycobacterium Avium Complex at an Academic Centre , 2004 .

[53]  Sylvia Bereknyei,et al.  Toward shared decision making at the end of life in intensive care units: opportunities for improvement. , 2007, Archives of internal medicine.

[54]  S. Aranda,et al.  Family meetings in palliative care: Multidisciplinary clinical practice guidelines , 2008, BMC palliative care.

[55]  M. Antonelli,et al.  Challenges in End-of-Life Care in the ICU: Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: Executive Summary , 2004, Intensive care medicine.