Recommendations
Table 1. Recommended Practices for Improving
Communication and Support for Surrogates
in the Intensive Care Unit
Systems-level interventions
Conduct regular, structured inter-professional family meetings
Integrate palliative care and/or ethics teams into ICU care for difficult cases
Provide printed educational materials to family
Maintain dedicated meeting space for ICU family meetings
Clinician-level skills
Coordinate an effective ICU family meeting
• Establish consensus among treating clinicians before the meeting
• Use a private, quiet space for family meetings
• Introduce all participants
• Use patient/family-centered communication strategies (see below)
• Affirm non-abandonment and support family decisions
Provide family-centered communication
• Elicit surrogates' perceptions first
• Use active listening skills and deliver information in small chunks
• Respond to questions and check for understanding of key facts
• Acknowledge and address emotion
• Support religious/spiritual needs and concerns
Foster shared decision-making
• Assess clinical prognosis and degree of certainty
• Evaluate surrogate preferences for decision-making responsibility
• Elicit the patient's treatment preferences and health-related values
