End of Life Care: Communication Challenges in Intensive Care Unit

Communication is a crucial point in end of life (EOL), and it is important to recognize and handle the difficulties of EOL communication. The objective of this review was to summarize current research and recommendations for Intensive Care Unit (ICU) EOL communication and to explore end of life communication challenges encountered within the ICU and to identify the strategies in overcoming these challenges. A comprehensive literature search was conducted to retrieve all relevant articles published. Databases like ProQuest, PubMed, Medline and Science Direct were systematically searched to identify the research and papers related specifically to challenges encountered in ICU during end of life care and the strategies to overcome those challenges by nurses. The articles that are published in English with end of life communication as a major theme, reporting studies with critically ill patient in the ICU settings and papers published after 2010 were included. The articles published in languages other than English with end of life communication as a secondary theme, reporting studies of general patients in acute, hospice or home setting and the papers published prior to 2010 were excluded. From 47 papers read in full, 17 were eligible in inclusion. Major end of life communication challenges in the ICU occurs due to lack of advance directives, disagreement of families over treatment options, absence of team and family meetings and lack of communication skills of critical care team. Effective end of life communication involves adequate training, good communication between the ICU team and the family and interdisciplinary collaboration. The findings of this review suggests that there is strong need to strengthen the end-of -life communication in ICUs in order to provide quality care which eventually leads to quicker palliative care transfers for patients who do not survive, as well as satisfaction of the family and critical team.