Being proactive in communication skills is increasingly becoming of importance for intensive care unit (ICU) physicians who deal with end-stage diseased patients to minimize ICU-related post-traumatic stress disorder (PTSD) among families of the patient. As physician divert his/her plan from definitive treatment to palliation, effective system of communication is essential for balancing patient/family's perception, expectations to reality and prognosis.
Following are several recommendations from the editorial article published in NEJM 356:513-515 (Feb 1, 2007):
1. Implementing proactive communication system: A five-part system, known by the mnemonic VALUE, includes the following elements: Valuing and appreciating what the family members communicate, Acknowledging their emotions by using reflective summary statements, Listening to family members, Understanding who the patient is as a person by asking open-ended questions and listening carefully to the responses, and Eliciting questions from the family more effectively than by simply asking, "Any questions?"
2. A key skill is listening more and talking less.
3. Formal bereavement meetings improves well-being and decrease PTSD, anxiety and depression among family members. ( Lautrette et al.)
4. Spending an average of 30 minutes (or 10 minutes longer than typical practice) with the patient's family members leads to a significant improvement in their well-being in the months after their loss. (Lautrette et al.)
5. Multidisciplinary communication system including bereavement conferences should be arranged in accordance with ethics and palliative care consultations.
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Wednesday, January 31, 2007
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2 comments:
My mother was in ICU for 43 days before she died. 43 days of screaming. I've been diagnosed with chronic PTSD and severe Major Depression. It's been 7 months and I still see, hear and smell it. Medications are useless, I'm suffer serotonin syndrome for the third time after being locked up for homicidal rage. Haven't slept in three days. Not that I have a hope in hell of sleeping shaking from head to toe. My quality of life sucks. Could this have been prevented?
I am sorry to learn your incident and understand effects of going through such painful circumstances. There are several treatment options - both medications and psychotherapy to relieve your symptoms, especially related to serotonin syndrome. I believe that you are not taking different kinds of medications for your previous PTSD and depression that can interact with one another leading to serotonin syndrome. Adhering to treatment regime as advised by your treating doctor in a regular, long-term manner along with strong will in yourself that things will be normal is the key for better quality of life. I pray for speedier recovery.
- Kevin
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