The research published today in open access journal BMC Medicine is the result of a three-year study to develop and test ways to improve communication and support in Intensive Care.
The study, which was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme, has developed a simple tool called PACE – which stands for Psychosocial Assessment and Communication Evaluation.
The goal of developing this tool was to improve assessment and communication for all patients in the ICU, both those who may deteriorate and equally those who may recover. PACE comprises of a training programme and an assessment, which is recorded in the person’s clinical record.
The training programme involves collaborative work between the ICU and hospital palliative care team to look at ways to improve the communication and how the PACE questions might serve as a prompt to improve social assessment and continue dialogue.
“This collaborative approach, both in research and training, has also improved day-to-day communication between the ICU and palliative care teams, facilitating improved patient and family care” said Dr Wendy Prentice, consultant and honorary senior lecturer in palliative medicine and clinical lead for the Palliative Care Team at King’s College Hospital.
Dr Phil Hopkins, consultant and honorary senior lecturer at Kings College Hospital, and senior intensivist on the study, explained how PACE might work:
“The background chronic health status, healthcare preferences, social history and psychology of patients with critical illness has historically received less attention than acute resuscitation or physical supportive care. Further, family relationships and communication between the critical care and next of kin has also been a neglected area. PACE provides a platform to better explore these issues in the hope that improved short and long term outcomes and quality of care will result.”
The clinical record within PACE asks for assessment of five aspects of care (see box). PACE is completed by the key worker for the patient, usually a nurse, within 24 hours of admission.
The record then gives space for a continuing log of any communication updates. This to accommodate a clinical shift change during the 24-hour period and ensure everyone is kept up to date.
“The Intensive Care Unit is a highly challenging environment for patients and families. Patients are normally profoundly ill and making communication very difficult. It is an unfamiliar place for families. Things can change quickly, and there is a lot of information for families to take in. For this reason, it is a place where communication and support can be very difficult and can often go wrong,” explained Professor Irene Higginson, lead author of the study.
The preliminary evaluation of PACE surveyed the views of family members on the ICU. Of the 213 family members, 165 (78%) responded to their survey.
Two-thirds had PACE completed and those families reported significantly higher (better) satisfaction with the honesty and consistency of information from staff and symptom control that patients received compared with those where it was not.
Staff also found PACE useful: of 95 ICU staff surveyed, 89% rated PACE as very or generally helpful.
Reports from the families when interviewed suggested that PACE helps the staff to get to know the patient and family better, helps them feel that someone listens to them and is interested in them and their wishes, as well as in the purely biomedical aspects of the disease.