MULTIDISCIPLINARY TEAM TRAINING TO ENHANCE FAMILY COMMUNICATION IN THE ICU (Shaw et al, Crit Care Med 2014; 42:265-71)
This was a pre-& post-intervention study of a MDT training programme for a group of 98 caregivers in a teaching hospital with three adult ICU’s. They trained in a standardised approach to communicating with families using the SPIKES protocol (setup, perception, invitation, knowledge, emotions, strategy/subsequent), followed by participation in a simulated family conference. Staff confidence in communicating with family members increased significantly. While there was no difference in overall family satisfaction with care in the ICU pre & post intervention, family members did report higher ratings of satisfaction with decision making post intervention. However, the family response rate was low (<16%)
Summary: Training staff in the ICU on communication skills improves staff confidence & family satisfaction in the decision making process.
DISTRESS AND PATIENT-CENTRED COMMUNICATION AMONG VETERNS WITH INCIDENTAL (NOT SCREEN-DETECTED) PULMONARY NODULES (Slatore et al, Ann Am Thorac Soc 2015; 12(2):184-92)
This study evaluated 122 veterans with incidentally detected nodules. It examined the association of communication processes with distress & the perceived risk of lung cancer. It found that veterans frequently reported an inadequate exchange of information regarding their nodules. Only 12% felt very informed about their nodule. Almost 50% experienced at least mild distress. Current smoking status & nodule size were associated with increased perceived risk. On average the perceived risk was 39%, while the actual calculated risk was only 10%.
Summary: Patients wanted more information on the causes of nodules, their risk of lung cancer & more discussion about their worries & fears.
PHYSICIAN-PATIENT COMMUNICATION ON COST AND AFFORDABILITY IN ASTHMA CARE: WHO WANTS TO TALK ABOUT IT & WHO IS ACTUALLY DOING IT (Patel et al, Ann Am Thorac Soc 2014; 11(10): 1538-44)
This was a cohort study of 442 African-American women with persistent asthma. It examined which patients wanted to discuss the cost of their asthma care with their physician, how often that communication is occurring & what characteristics were predictive of that communication occurring. 52% of women perceived a financial burden in relation to the cost of their asthma care. Mean out-of-pocket expense for medications was $143 (range $0 – $2840). 72% wanted to discuss cost with their physician but only 39% actually did so. Most often, patients initiated the conversation. Those who actually have had a conversation with their physician were more likely to have worse asthma control & lower asthma-related quality of life.
Summary: Physicians should enquire about affordability with all patients when providing therapeutic asthma recommendations.