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Open Access 01-12-2016 | Research article

Mismatch between physicians and family members views on communications about patients with chronic incurable diseases receiving care in critical and intensive care settings in Georgia: a quantitative observational survey

Authors: Nana Chikhladze, Elene Janberidze, Mariam Velijanashvili, Nikoloz Chkhartishvili, Memed Jintcharadze, Julia Verne, Dimitri Kordzaia

Published in: BMC Palliative Care | Issue 1/2016

Abstract

Background

Physicians working in critical and intensive care settings encounter death of chronic incurable patients on a daily basis; however they have scant skills on how to communicate with the patients and their family members. The aim of the present survey is to examine communication of critical and intensive care physicians with patients’ family members receiving treatment due to chronic incurable diseases/conditions and to compare the views of families with physicians working in critical and intensive care settings.

Methods

The survey was conducted in four cities of Georgia (Tbilisi, Kutaisi, Batumi and Telavi) in 2014. Physicians working in critical and intensive care settings and family members were asked to fill in separate questionnaires, covering various aspects of communication including patients’ prognosis, ways of death occurrence, treatment plans and religion. Participants ranked their responses on a scale ranging from “0” to “10”, where “0” represented “never” and “10”-“always”. After data collection, responses were recoded into three categories: 0–3 = never/rarely, 4–7 = somewhat and 8–10 = often/always. Differences were tested using Pearson’s chi-square or Fisher’s exact test as appropriate. P value of < 0.05 was considered as significant.

Results

Sixty-five physicians and 59 patients’ family members participated in this cross-sectional study. Majority of their responses was statistically significantly different. Only one quarter (23.7 %) of family members of patients receiving medical aid in critical and intensive care settings were satisfied with the communication level. In contrast, 78.5 % of physicians considered their communication with families as positive (p < 0.0001).

Conclusions

The survey revealed the mismatch between the views on communication of critical and intensive care settings physicians and family members of the patients with chronic incurable diseases receiving care in critical and intensive care settings. In order to provide the best care for chronic incurable patients and their family members, physicians working in critical and intensive care settings must have relevant clinical knowledge and ability to provide effective communication. Present results reflect important potential targets for educational interventions including critical and intensive care physicians training through online modules.

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Bekelman JE, Halpern SD, Blankart CR, Bynum JP, Cohen J, Fowler R, et al. Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. Jama. 2016;315(3):272–83. doi:10.1001/jama.2015.18603.CrossRefPubMed

Vincent JL, Berre J, Creteur J. Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective. Chron Respir Dis. 2004;1(2):115–20.CrossRefPubMed

Gomes B, Higginson IJ, Calanzani N, et al. PRISMA. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann Oncol. 2012;23(8):2006–15.CrossRefPubMed

Field MJ, Cassel CK. Approaching death: improving care at the end of life. National Academies Press; 1997 Oct 16.

De Roo ML, Leemans K, Claessen SJ, Cohen J, Pasman HR, Deliens L, et al. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manage. 2013;46(4):556–72. doi:10.1016/j.jpainsymman.2012.09.013.CrossRefPubMed

Addington-Hall J, Altmann D, McCarthy M. Variations by age in symptoms and dependency levels experienced by people in the last year of life, as reported by surviving family, friends and officials. Age Ageing. 1998;27(2):129–36.CrossRefPubMed

Grudzen CR, Stone SC, Morrison RS. The palliative care model for emergency department patients with advanced illness. J Palliat Med. 2011;14(8):945–50. doi:10.1089/jpm.2011.0011.CrossRefPubMedPubMedCentral

Palda VA, Bowman KW, Mclean RF, Chapman MG. “Futile” care: do we provide it? Why? a semistructured, Canada-wide survey of intensive care unit doctors and nurses. J Crit Care. 2005;20(3):207–13. doi:10.1016/j.jcrc.2005.05.006.CrossRefPubMed

Smith AK, Fisher J, Schonberg MA, Pallin DJ, Block SD, Forrow L, et al. Am I doing the right thing? provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009;54(1):86–93. doi:10.1016/j.annemergmed.2008.08.022. e1.CrossRefPubMed

10.

Stone SC, Mohanty S, Grudzen CR, Shoenberger J, Asch S, Kubricek K, et al. Emergency medicine physicians’ perspectives of providing palliative care in an emergency department. J Palliat Med. 2011;14(12):1333–8. doi:10.1089/jpm.2011.0106.CrossRefPubMed

11.

Seymour JE. Negotiating natural death in intensive care. Soc Sci Med. 2000;51(8):1241–52. doi:10.1016/S0277-9536(00)00042-3.CrossRefPubMed

12.

Kordzaia D, Dalakishvili S, Gvamichava R, Rukhadze T, Abesadze I, Dzotsenidze P et al. Georgian National Program For Palliative Care, Action Plan for 2011 – 2015. 2011. (unpublished data).

13.

Minister of Labour, Health, and Social Affairs of Georgia. Decree №136/N, Date of issuing: 18/04/2007 (with amendments in 07.02.2014). https://matsne.gov.ge/en/document/view/70162. Accessed 21 June 2016.

14.

Johnson DC, Kutner JS, Armstrong 2nd JD. Would you be surprised if this patient died?: preliminary exploration of first and second year residents’ approach to care decisions in critically ill patients. BMC palliative care. 2003;2(1):1.CrossRefPubMedPubMedCentral

15.

Rukhadze T., Kordzaia D., Velijanashvili M., Chikhladze N. Report of Survey funded by “Open Society—Georgia Foundation”(unpublished data). 2010

16.

Luce JM. End-of-life decision making in the intensive care unit. Am J Respir Crit Care Med. 2010;182(1):6–11. doi:10.1164/rccm.201001-0071CI.CrossRefPubMed

17.

Morgan J. End-of-life care in UK critical care units—a literature review. Nurs Crit Care. 2008;13(3):152–61. doi:10.1111/j.1478-5153.2008.00274.x.CrossRefPubMed

18.

Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American college [corrected] of critical care medicine. Crit Care Med. 2008;36(3):953–63. doi:10.1097/CCM.0B013E3181659096.CrossRefPubMed

19.

Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, et al. Recommendations for end-of-life care in the intensive care unit: the ethics committee of the society of critical care medicine. Crit Care Med. 2001;29(12):2332–48.CrossRefPubMed

20.

Agresti A. An introduction to categorical data analysis. 2nd ed. Wiley series in probability and mathematical statistics. Hoboken: Wiley-Interscience; 2007.CrossRef

21.

Government of Georgia, On Approval of the 2014–2020 State Concept of Healthcare System of Georgia for ‘Universal Health Care and Quality Control for the Protection of Patients’ Rights’,. Registration code 470020000.10.003.018343 (26/12/2014).

22.

Lynn J. Improving care for the end of life: A sourcebook for health care managers and clinicians. Oxford University Press; 2008.

23.

Mazor KM, Beard RL, Alexander GL, Arora NK, Firneno C, Gaglio B, et al. Patients’ and family members’ views on patient-centered communication during cancer care. Psychooncology. 2013;22(11):2487–95. doi:10.1002/pon.3317.CrossRefPubMed

24.

Deledda G, Moretti F, Rimondini M, Zimmermann C. How patients want their doctor to communicate. A literature review on primary care patients’ perspective. Patient Educ Couns. 2013;90(3):297–306. doi:10.1016/j.pec.2012.05.005.CrossRefPubMed

25.

Gomez-Batiste X, Caja C, Espinosa J, Bullich I, Martinez-Munoz M, Porta-Sales J, et al. The Catalonia world health organization demonstration project for palliative care implementation: quantitative and qualitative results at 20 years. J Pain Symptom Manage. 2012;43(4):783–94. doi:10.1016/j.jpainsymman.2011.05.006.CrossRefPubMed

26.

Gomez-Batiste X, Stjernsward J, Espinosa J, Martinez-Munoz M, Trelis J, Constante C. How to design and implement palliative care public health programmes: foundation measures. An operational paper by the WHO collaborating centre for public health palliative care programmes at the Catalan institute of oncology. BMJ Support Palliat Care. 2013;3(1):18–25. doi:10.1136/bmjspcare-2012-000215.CrossRefPubMed

27.

Stjernsward J.: Public health WHO perspective. In: Cohen J, Deliens L.: A public health perspective on end of life care. Oxford University Press; 2012 Jan 19., pp. 195–207

28.

World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course. J Pain Palliat Care Pharmacother. 2014;28(2):130–4.CrossRef

29.

Eidelman LA, Jakobson DJ, Pizov R, Geber D, Leibovitz L, Sprung CL. Foregoing life-sustaining treatment in an Israeli ICU. Intensive Care Med. 1998;24(2):162–6.CrossRefPubMed

30.

A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. Jama. 1995;274 (20):1591–8.

31.

McLean RF, Tarshis J, Mazer CD, Szalai JP. Death in two Canadian intensive care units: institutional difference and changes over time. Critical Care Medicine. 2000;28(1):100–3.CrossRefPubMed

32.

Danis M. Improving end-of-life care in the intensive care unit: What’s to be learned from outcomes research? New Horiz. 1998;6:110–8.PubMed

33.

Curley MAQ, Meyer EC. The impact of the critical care experience on the family. In: critical care nursing of infants and children. Philadelphia: WB Saunders; 1999.

34.

Furukawa MM. Meeting the needs of the dying patient’s family. Crit Care Nurse. 1996;16(1):51–7.PubMed

35.

Nelson JE, Cortez TB, Curtis JR, Lustbader DR, Mosenthal AC, Mulkerin C, et al. Integrating palliative care in the ICU: the nurse in a leading role. J Hosp Palliat Nurs : JHPN : off j Hosp Palliat Nurs Assoc. 2011;13(2):89–94. doi:10.1097/NJH.0b013e318203d9ff.CrossRef

36.

Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, et al. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med. 2010;38(9):1765–72. doi:10.1097/CCM.0b013e3181e8ad23.CrossRefPubMedPubMedCentral

37.

Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients’ perspectives. Jama. 1999;281(2):163–8.CrossRefPubMed

38.

Munhoz BA, Paiva HS, Abdalla BMZ, Zaremba G, Rodrigues AMP, Carretti MR, et al. From one side to the other: what is essential? perception of oncology patients and their caregivers in the beginning of oncology treatment and in palliative care. Einstein (São Paulo). 2014;12:485–91.CrossRef

39.

Siaarti Italian Society of Anaesthesia Analgesia Resuscitation Intensive Care Bioethical Board. End-of-life care and the intensivist: SIAARTI recommendations on the management of the dying patient. Minerva Anestesiol. 2006;72(12):927–63.

40.

Clarke EB, Curtis JR, Luce JM, Levy M, Danis M, Nelson J, et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003;31(9):2255–62. doi:10.1097/01.CCM.0000084849.96385.85.CrossRefPubMed

41.

Cook D, Rocker G, Heyland D. Dying in the ICU: strategies that may improve end-of-life care. Canadian journal of anaesthesia = Journal canadien d’anesthesie. 2004;51 (3):266–72. doi:10.1007/BF03019109.

42.

Stjernswärd J. National palliative care program: Georgia; 2006. http://www.parliament.ge/files/619_8111_336972_Paliativi-Eng.pdf.

43.

PLOS Medicine Editors. Observational studies: getting clear about transparency. PLoS Med. 2014;11(8):e1001711.

Title: Mismatch between physicians and family members views on communications about patients with chronic incurable diseases receiving care in critical and intensive care settings in Georgia: a quantitative observational survey
Authors: Nana Chikhladze
Elene Janberidze
Mariam Velijanashvili
Nikoloz Chkhartishvili
Memed Jintcharadze
Julia Verne
Dimitri Kordzaia
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Palliative Care / Issue 1/2016
Electronic ISSN: 1472-684X
DOI: https://doi.org/10.1186/s12904-016-0135-2

At a glance: The STEP trials

Springer Medicine

Mismatch between physicians and family members views on communications about patients with chronic incurable diseases receiving care in critical and intensive care settings in Georgia: a quantitative observational survey

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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