Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: An observational study in an intensive care unit

Sharyn L Milnes; Debra C Kerr; Ana Hutchinson; Nicholas B Simpson; Yianni Mantzaridis; Charlie Corke; Michael Bailey; Neil R Orford

doi:10.1016/j.ccrj.2023.04.005

Effect of communication skills training on documentation of shared decision-making for patients with life-limiting illness: An observational study in an intensive care unit

Crit Care Resusc. 2023 May 20;25(1):20-26. doi: 10.1016/j.ccrj.2023.04.005. eCollection 2023 Mar.

Authors

Sharyn L Milnes^{1

2

3}, Debra C Kerr², Ana Hutchinson², Nicholas B Simpson^{1

3}, Yianni Mantzaridis¹, Charlie Corke¹, Michael Bailey⁴, Neil R Orford^{1

3

4

5}

Affiliations

¹ University Hospital Geelong, Barwon Health, Geelong, Australia.
² Institute for Healthcare Transformation, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia.
³ Institute for Innovation in Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, Australia.
⁵ Department of Critical Care, University of Melbourne, Australia.

Abstract

Objectives: This article aims to examine the association between a shared decision-making (SDM) clinical communication training program and documentation of SDM for patients with life-limiting illness (LLI) admitted to intensive care.

Methods: This article used a prospective, longitudinal observational study in a tertiary intensive care unit (ICU). Outcomes included the proportion of patients with SDM documented on an institutional Goals of Care Form during hospital admission, as well as characteristics, outcomes, and factors associated with an SDM admission.

Intervention: Clinical communication skills training (iValidate) and clinical support program are the intervention for this study.

Results: A total of 325 patients with LLI were admitted to the ICU and included in the study. Overall, 184 (57%) had an SDM admission, with 79% of Goals of Care Form completed by an iValidate-trained doctor. Exposure to an iValidate-trained doctor was the strongest predictor of an ICU patient with LLI having an SDM admission (odds ratio: 22.72, 95% confidence interval: 11.91-43.54, p < 0.0001). A higher proportion of patients with an SDM admission selected high-dependency unit-level care (29% vs. 12%, p < 0.001) and ward-based care (36% vs. 5%, p < 0.0001), with no difference in the proportion of patients choosing intensive care or palliative care. The proportion of patients with no deterioration plan was higher in the non-SDM admission cohort (59% vs. 0%, p < 0.0001).

Conclusions: Clinical communication training that explicitly teaches identification of patient values is associated with improved documentation of SDM for critically ill patients with LLI. Understanding the relationship between improved SDM and patient, family, and clinical outcomes requires appropriately designed high-quality trials randomised at the patient or cluster level.

Keywords: Autonomy; Communication; Goal concordant care; Life-limiting illness; Shared decision-making; Values.