Abstract:
OBJECTIVES:Conflict is common between physicians and surrogate decision makers around end-of-life care in ICU. Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences in how palliative care specialists manage conflict with surrogates about end-of-life treatment decisions in ICUs compared with intensivists. DESIGN:Subjects participated in a high-fidelity simulation of conflict with a surrogate in an ICU. In this simulation, a medical actor portrayed a surrogate decision maker during an ICU family meeting who refuses to follow an advance directive that clearly declines advanced life-sustaining therapies. We audiorecorded the simulation encounters and applied a coding framework to quantify conflict management behaviors, which was organized into two categories: task-focused communication and relationship building. We used negative binomial modeling to determine whether there were differences between palliative care specialists' and intensivists' use of task-focused communication and relationship building. SETTING:Single academic medical center ICU. SUBJECTS:Palliative care specialists and intensivists. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We enrolled 11 palliative care specialists and 25 intensivists. The palliative care specialists were all attending physicians. The intensivist group consisted of 11 attending physicians, 9 pulmonary and critical care fellows, and 5 internal medicine residents rotating in the ICU. We excluded five residents from the primary analysis in order to reduce confounding due to training level. Physicians' mean age was 37 years with a mean of 8 years in practice. Palliative care specialists used 55% fewer task-focused communication statements (incidence rate ratio, 0.55; 95% CI, 0.36-0.83; p = 0.005) and 48% more relationship-building statements (incidence rate ratio, 1.48; 95% CI, 0.89-2.46; p = 0.13) compared with intensivists. CONCLUSIONS:We found that palliative care specialists engage in less task-focused communication when managing conflict with surrogates compared with intensivists. These differences may help explain the benefit of palliative care involvement in conflict and could be the focus of interventions to improve clinicians' conflict resolution skills.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Chiarchiaro J,White DB,Ernecoff NC,Buddadhumaruk P,Schuster RA,Arnold RMdoi
10.1097/CCM.0000000000001583subject
Has Abstractpub_date
2016-05-01 00:00:00pages
934-42issue
5eissn
0090-3493issn
1530-0293journal_volume
44pub_type
杂志文章abstract::By definition, the acute respiratory distress syndrome is associated with diffuse cellular infiltration and proteinaceous edema. It is generally believed that the widespread injury that characterizes acute respiratory distress syndrome is a process that is launched almost synchronously throughout the lung, caused by b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181f20f01
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abstract:OBJECTIVE:To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING:San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN:A standardized questionnaire was used to collect data on demographics and functional outcome of severe...
journal_title:Critical care medicine
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abstract:OBJECTIVES:The epidemiology of chronic critical illness is not well known. We aimed to estimate the prevalence, mortality, and costs associated with chronic critical illness in Japan. DESIGN:A nationwide inpatient administrative database study in Japan from April 2011 to March 2018. SETTING:Six hundred seventy-nine a...
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doi:10.1097/CCM.0000000000001299
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abstract:OBJECTIVE:Physiologic and pathologic comparison of two modes of assisted ventilation, nasal intermittent positive-pressure ventilation (NIPPV) and synchronized intermittent mandatory ventilation (SIMV), in spontaneously breathing term newborn piglets with saline lavage-induced lung injury. DESIGN:After inducing acute ...
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doi:10.1097/01.CCM.0000295311.61378.7D
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...
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doi:10.1097/00003246-199201000-00012
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journal_title:Critical care medicine
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doi:10.1097/00003246-198106000-00012
更新日期:1981-06-01 00:00:00
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doi:10.1097/CCM.0000000000004667
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199005000-00014
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更新日期:2015-11-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2011-01-01 00:00:00
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