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Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study
  1. Neil R Orford1,2,3,
  2. Sharyn Milnes1,2,
  3. Nicholas Simpson1,2,
  4. Gerry Keely1,
  5. Tania Elderkin1,
  6. Allison Bone1,
  7. Peter Martin2,4,
  8. Rinaldo Bellomo3,5,
  9. Michael Bailey3 and
  10. Charlie Corke1,2
  1. 1 Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
  2. 2 School of Medicine, Deakin University, Geelong, Australia
  3. 3 Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, Australia
  4. 4 Palliative Care Unit, Barwon Health, Geelong, Australia
  5. 5 School of Medicine, The University of Melbourne, Parkville, Melbourne, Australia
  1. Correspondence to Neil R Orford, Intensive Care Unit, University HospitalGeelong, Barwon Health, VIC, 3220; neilo{at}barwonhealth.org.au

Abstract

Objectives To describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management.

Methods Prospective before-and-after cohort study in a tertiary teaching hospital in Australia. The population was 222 adult patients with LLI referred to the intensive care unit (ICU). The study was divided into two periods, before (1 May to 31 July 2015) and after (15 September to 15December 2015) the intervention. The intervention was a 2-day, small group, simulated-patient, communication skills course, and process of care for patients with LLI. The primary outcome was documentation of patient-centred goals of care discussion (PCD) within 48 hours of referral to the ICU. Secondary outcomes included clinical outcomes and 90-day mortality.

Results The intervention was associated with increased documentation of a PCD from 50% to 69% (p=0.004) and 43% to 94% (p<0.0001) in patients deceased by day 90. A significant decrease in critical care as the choice of resuscitation goal (61% vs 42%, p=0.02) was observed. Although there was no decrease in admission to ICU, there was a significant decrease in medical emergency team call prevalence (87% vs 73%, p=0.009). The cancer and organ failure groups had a significant decrease in 90-day mortality (75% vs 44%, p=0.02; 42% vs 16%, p=0.01), and the frailty group had a significant decrease in 90-day readmissions (48% vs 19%, p=0.003).

Conclusions The intervention was associated with increased PCD documentation and decrease in the choice of critical care as the resuscitation goal. Admissions to ICU did not decrease, and although limited by study design, condition-specific trajectory changes, clinical interventions and outcomes warrant further study.

  • patient choices
  • end-of-life care
  • communication
  • education and training
  • intensive care
  • life-limiting illness

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Footnotes

  • Contributor NO: planning, data analysis, manuscript development and revision, guarantor of overall content and development of tables and figures. SM: planning, manuscript development and revision, data collection and analysis, figures development and submitted study. NS: planning, data analysis and manuscript revision. GK: planning, data collection and manuscript revision. AB and TE: data collection, manuscript revision and submission process. PM and RB: manuscript revision. MB: statistical analysis and manuscript development and revision. CC: planning and manuscript revision.

  • Competing interests None declared.

  • Patient consent Methods were medical record audit only. All data was collected anonymously.

  • Ethics approval Ethics approval from the Barwon health research and ethics committee was obtained prior to commencement of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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