The family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvement

The intensive care unit (ICU) represents a hospital setting in which death and discussion about end-of-life care are common. yet these conversations a m often difficult Such difficulties arise, in part, because a family may be facing an unexpected poor prognosis associated with an acute illness or ex acerbation and, in part, because the ICU orientation is one of saving lives , Understanding and improving communication about end-of-life care between clinicians and families in the ICU is an important focus for improving the quality of care in the ICU, This communication often occurs in the "family conference" attended by several family members and members of the ICU team, including physicians, nurses, and social workers, In this article, we revi ew the importance of communication about end-of-life cam during the family conference and make specific recommendations for physicians and nurses inte rested in improving the quality of their communication about end-of-life ca re with family members. Because excellent end-of-life care is an important part of high-quality intensive care, ICU clinicians should approach the fam ily conference with the same care and planning that they approach other ICU procedures. This article outlines specific steps that may facilitate good communication about end-of-life care in Be ICU before, during, and after th e conference, The article also provides direction for the future to improve physician-family and nurse-family communication about end-of-life care in the ICU and a research agenda to improve this communication. Research to ex amine and improve communication about end-of-life care in the ICU must proc eed in conjunction with ongoing empiric efforts to improve the quality of c are we provide to patients who die during or shortly after a stay in the IC U.