E‐ICU/CommunicationA pilot study of audiovisual family meetings in the intensive care unit☆
Introduction
Family meetings in the intensive care unit (ICU) are crucial in determining the desired outcome for patients who are often not competent or able to communicate. A common limitation of these meetings is the absence of relatives or loved ones because of geographical constraints. There is frequently uncertainty about the patient’s wishes; and a consensus that is reached by several smaller family meetings has the potential to be less representative, comforting, or satisfactory. Virtual family meetings, which use audiovisual technology to bridge geographical constraints, are well suited for addressing this concern. Through the use of conference calling and videoconferencing, it is possible to have family members and medical providers who are physically present in the ICU communicate with other family members, friends, or physicians.
Productive family meetings can lessen bereavement and facilitate decisions concerning code status, palliative care consultation, mechanical ventilation, and dialysis. Prior studies have demonstrated this effect using communicative strategies such as multidisciplinary provider teams [1], more proactive and intensive conferences [2], and bereavement brochures [3]. The effect of using videoconferencing and conference calling has not been studied. The guidelines for ICU family conferences from the American College of Critical Care [4] advocate multiple strategies to improve the effectiveness of family meetings, but increasing the participation of the patient’s family through audiovisual conferencing or other multimedia platforms is not addressed. We hypothesized that a virtual family meeting with conference calling and Skype videoconferencing would increase family member satisfaction, which is inherently beneficial, but also correlates with better patient care [5]. We also hypothesized that the enhanced discourse in audiovisual meetings would result in more robust decisions about patient care.
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Methods
We conducted a prospective, nonblinded, nonrandomized pilot study with 2 stages from 2010 to 2012. During the first stage, we administered a 6-question survey (Fig. 1) to willing family members of incapacitated patients after standard family meetings in the neurocritical care unit of a large academic hospital. The survey had 7 possible categorical responses, ranging from strongly agree to strongly disagree, for each of the 6 questions, which probed satisfaction with the meeting and the
Results
During the first stage, 38 family members took the survey during 12 family meetings. During the second stage, 50 family members completed the survey after 10 family meetings, 6 (60%) of which included the audiovisual intervention. Five of these 6 audiovisual family meetings used conference calling, and 1 used Skype. Overall, 29 (33%) of the completed surveys came from audiovisual family meetings vs 59 (67%) from control meetings.
Median number of family members present at the meetings was 3
Discussion
Families and surrogates struggle with a multitude of difficult decisions when a loved one is in the ICU, which can lead to anxiety, depression, and overwhelming grief. Critical care medicine has improved and sicker patients are living longer, making the decision process regarding goals of care and treatment options even more important. Research continues to highlight the limitations of advance directives and similar documents, lending increasing prominence to the end-of-life family conference
Conclusion
In light of its limitations, this pilot study neither refutes nor encourages audiovisual interventions in the ICU. Our study demonstrates that an audiovisual intervention was welcomed in a sizable percentage of family meetings and did not have an adverse impact on satisfaction or other metrics. Given that the intervention was feasible in this pilot study, audiovisual and multimedia intervention strategies, like social media groups or secure chat rooms, should be further investigated for their
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How to communicate with family members of the critically ill in the intensive care unit: A scoping review
2023, Intensive and Critical Care NursingCitation Excerpt :Interdisciplinary family meetings were held every three days or earlier, and goals-of-care meetings were held every seven days or earlier (Kerckhoffs et al., 2020; Machare Delgado et al., 2009). Using conference calling or Skype teleconferencing did not affect the families’ satisfaction with the meetings (de Havenon et al., 2015). It was recommended to establish a documentation pathway for the meetings, e.g., as a meeting documentation template in the patient’s chart, to record the discussed patient's wishes, health condition, treatment plan, and prognosis, and short-term and medium-term goals (Kumpf et al., 2019).
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The authors report no conflicts of interest and have no financial disclosures. This study had no funding.