Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient
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PALLIATIVE CARE IN TRAUMA (L MAERZ, SECTION EDITOR)
Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient Mackenzie Cook 1 & David Zonies 1 & Karen Brasel 1 Accepted: 15 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees. Keywords Palliative care . Goals of care . Comfort care . Communication
Introduction In 2005, the American College of Surgeons called upon surgeons to provide high-quality palliative care to ALL patients with serious illness, not just those approaching the end of their life [1••]. Comprehensive care of the acutely injured and critically ill patient is the defining skill set of the acute care surgeon and an essential part of that skill set is the ability to communicate clearly, effectively, and efficiently with the patient and their family. Communicating clearly as part of providing high-quality palliative care in the intensive care unit (ICU) is about guiding difficult decisions, defining goals of care, explaining the impact of acute surgical problems on future quality of life, and facilitating transitions to end of life care [2, 3]. It is critically important to understand that essential communication skills can be learned and taught [4, 5].
This article is part of the Topical Collection on Palliative Care in Trauma * Mackenzie Cook [email protected] 1
Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230, USA
The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. We will discuss communication through all phases of trauma care, review specific literature on guiding family meetings, and discuss strategies to teach these skills.
Clinical and Research Need The acuity of trauma patients admitted to ICUs in the USA is very high, with a diversity of pathologies [6]. Roughly one in five Americans will die in hospital after receiving ICU level care [7]. When approaching the acutely injured and critically ill trauma patient, it is important to keep in mind the general observation that the seriously ill often value quality of
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