81 Background: Death in the ICU is an extraordinarily stressful event. Qualitative and quantitative studies have identified effective communication between caregivers and families to be important throughout the decision making process. In many ICUs, the end-of-life family conference is an opportunity to ask questions, express concerns, and confront painful emotions with the help of compassionate professionals. Methods: A prospective study in a single ICU center. The ICU physician, palliative care team, and research nurse interviewed surrogate decision makers. The only criterion for inclusion in the study was anticipated death in one year. Patients younger than 18 were excluded from the study, as were those unable to speak English. Prior to the family meeting, families were offered an opportunity to watch a video on EOL decision-making made by the research team. The meeting itself followed a script, guided by four steps:establish diagnosis, share prognosis, elicit goals of care, recommend treatment. The investigators recorded ICU and patient characteristics on standardized forms. Results: 22 families were included. A decision to forego life-sustaining treatment and transition to comfort care or hospice was pursued by 77% of families. There were few non-beneficial interventions, such as CRRT or use of artificial nutrition; withdrawal of mechanical ventilation and vasopressors was common. Qualitative commentary suggested that time spent by providers were sufficient and the video support tool was clear and easy to understand. Conclusions: EOL family conferences improve communication between ICU staff and family members and assist families in decision making, especially for cancer syndromes. The structured family meetings offered opportunities to discuss patient’s wishes, alleviate feelings of guilt, and understand the goals of care. Patients received few non-beneficial treatments and families were likely to accept realistic goals of care. This highlights the potential role for video-support tools in advance care planning. Future studies reporting overall LOS and bereavement data are important quality markers and pending in a future report.
Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic
