Transitions: When we speak, what do families really hear?
Harleah G. Buck PhD, RN, CHPN

January 2013 
Volume 43  Number 1
Pages 14 - 15
  PDF Version Available!

AS A HOSPICE NURSE, I was generally amazed by the responses I'd get when I asked patients or their family members, "So, what did your doctor tell you about your condition?" The answers often revealed a vastly incomplete or inaccurate understanding of the disease or prognosis.Clear communication in healthcare is pretty difficult at the best of times, and end-of-life discussions are more likely to occur at the worst of times-in the middle of the night in a busy ED, or between codes in an ICU.Several readers have asked me to discuss end-of-life conversations in the ICU, particularly the topic of futile treatment. Before we can even begin to unpack this complex topic, we need to understand the family piece-particularly what they believe about what's happening to their loved one.One of my favorite blogs, GeriPal ( ), highlighted two recent studies that explored what goes through a family member's mind when he or she has to make decisions for a loved one in the ICU. In one study,1 researchers explored the attitudes of ICU patients' families about whether their physician can predict what's futile, and how their opinion about the physician's ability to predict futile care influences their willingness to discontinue life support when they're told that continuing life support would be futile.Fifty family members were interviewed using a hypothetical clinical scenario. They were then asked, "If the doctor thought there was absolutely no chance for your loved one to survive the hospitalization, would you believe the doctor? Why or why not?" Sixty-four percent of family members said they wouldn't believe the physician. When asked to give a reason, the most common response was that they were skeptical about a physician's (or any human's) ability to predict the future. The second most common reason was that God could intervene in the situation. Thirty percent of the doubting family members described conducting prognostic evaluations of their own by gathering

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