Family-clinician communication in the ICU and its relationship to psychological distress of family members: A cross-sectional study

Abstract

Background: Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms.

Objectives: To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs).

Design: A cross-sectional study.

Settings and participants: The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea.

Methods: Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis.

Results: The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = -.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates.

Conclusions: The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.

Keywords: Communication; End-of-life care; Family; Intensive care unit; Psychological stress.