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Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review
INTRODUCTION: Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe phy...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258302/ https://www.ncbi.nlm.nih.gov/pubmed/25403291 http://dx.doi.org/10.1186/s13054-014-0604-z |
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author | Visser, Mieke Deliens, Luc Houttekier, Dirk |
author_facet | Visser, Mieke Deliens, Luc Houttekier, Dirk |
author_sort | Visser, Mieke |
collection | PubMed |
description | INTRODUCTION: Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. METHOD: Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. RESULTS: Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition. CONCLUSIONS: We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0604-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4258302 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42583022014-12-08 Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review Visser, Mieke Deliens, Luc Houttekier, Dirk Crit Care Research INTRODUCTION: Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. METHOD: Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. RESULTS: Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition. CONCLUSIONS: We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0604-z) contains supplementary material, which is available to authorized users. BioMed Central 2014-11-18 2014 /pmc/articles/PMC4258302/ /pubmed/25403291 http://dx.doi.org/10.1186/s13054-014-0604-z Text en © Visser et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Visser, Mieke Deliens, Luc Houttekier, Dirk Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title | Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title_full | Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title_fullStr | Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title_full_unstemmed | Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title_short | Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
title_sort | physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258302/ https://www.ncbi.nlm.nih.gov/pubmed/25403291 http://dx.doi.org/10.1186/s13054-014-0604-z |
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