There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development.
Methods:
Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar.
Results:
Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified.
Conclusion:
Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
AslaksonRChengJVollenweiderDGaluscaDSmithTJPronovostPJ. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014;17(2):219–235.
2.
MularskiRACurtisJRBillingsJA. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med. 2006;34(11):S404–S411.
3.
FawoleOADySMWilsonRF. A systematic review of communication quality improvement interventions for patients with advanced and serious illness. J Gen Intern Med. 2013;28(4):570–577.
4.
MularskiRAPuntilloKVarkeyB. Pain management within the palliative and end-of-life care experience in the ICU. Chest. 2009;135(5):1360–1369.
5.
ShawEAMarshallDHowardMTaniguchiAWinemakerSBurnsS. A systematic review of postgraduate palliative care curricula. J Palliat Med. 2010;13(9):1091–1108.
6.
MularskiRAHansenLRosenkranzSJLeoMCNagyPAschSM. Medical record quality assessments of palliative care for intensive care unit patients. Do they match the perspectives of nurses and families?Ann Am Thorac Soc. 2016;13(5):690–698.
7.
GamondiCLarkinPPayneS. Core competencies in palliative care: an EAPC White Paper on palliative care education—part 1. Eur J Palliat Care. 2013;20(2):2013.
8.
GamondiCLarkinPPayneS. Core competencies in palliative care: an EAPC White Paper on palliative care education—part 2. Eur J Palliat Care. 2013;20(3):2013.
9.
MoherDLiberatiATetzlaffJAltmanDG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269.
10.
SchaeferKGBlockSD. Physician communication with families in the ICU: evidence-based strategies for improvement. Curr Opin Crit Care. 2009;15(6):569–577.
11.
EvesMMEsplinBS. “She just doesn’t know him like we do”: illuminating complexities in surrogate decision making. J Clin Ethics. 2015;26(4):350–354.
12.
WhiteDBEvansLRBautistaCALuceJMLoB. Are physicians’ recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate. Am J Respir Crit Care Med. 2009;180(4):320–325.
13.
ApatiraLBoydEAMalvarG. Hope, truth, and preparing for death: perspectives of surrogate decision makers. Ann Intern Med. 2008;149(12):861–868.
14.
FassierTAzoulayE. Conflicts and communication gaps in the intensive care unit. Curr Opin Crit Care. 2010;16(6):654–665.
15.
ZierLSBurackJHMiccoGChipmanAKFrankJAWhiteDB. Surrogate decision makers’ responses to physicians’ predictions of medical futility. Chest. 2009;136(1):110–117.
16.
LuceJM. End-of-life decision making in the intensive care unit. Am J Respir Crit Care Med. 2010;182(1):6–11.
17.
RadwanySAlbaneseTCloughLSimsLMasonHJahangiriS. End-of-life decision making and emotional burden: placing family meetings in context. Am J Hosp Palliat Med. 2009;26(5):376–383.
18.
NelsonJEPuntilloKAPronovostPJ. In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med. 2010;38(3):808–818.
19.
GriesCJCurtisJRWallRJEngelbergRA. Family member satisfaction with end-of-life decision making in the ICU. Chest. 2008;133(3):704–712.
20.
StapletonRDEngelbergRAWenrichMDGossCHCurtisJR. Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med. 2006;34(6):1679–1685.
21.
HojatMGonnellaJSNascaTJMangioneSVergareMMageeM. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159(9):1563–1569.
22.
FinsJJSolomonMZ. Communication in intensive care settings: the challenge of futility disputes. Crit Care Med. 2001;29(2 suppl):N10–N15.
23.
EvansLRBoydEAMalvarG. Surrogate decision-makers’ perspectives on discussing prognosis in the face of uncertainty. Am J Respir Crit Care Med. 2009;179(1):48–53.
24.
KrossEKEngelbergRADowneyL. Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians. Chest. 2014;145(2):313–321.
25.
SchusterRAHongSYArnoldRMWhiteDB. Investigating conflict in ICUs-is the clinicians’ perspective enough?Crit Care Med. 2014;42(2):328–335.
26.
SelphRBShiangJEngelbergRCurtisJRWhiteDB. Empathy and life support decisions in intensive care units. J Gen Intern Med. 2008;23(9):1311–1317.
27.
WallRJCurtisJRCookeCREngelbergRA. Family satisfaction in the ICU: differences between families of survivors and nonsurvivors. Chest. 2007;132(5):1425–1433.
28.
OsbornTRCurtisJRNielsenELBackALShannonSEEngelbergRA. Identifying elements of ICU care that families report as important but unsatisfactory decision-making, control, and ICU atmosphere. Chest. 2012;142(5):1185–1192.
29.
HuffinesMJohnsonKLNaranjoLLS. Improving family satisfaction and participation in decision making in an intensive care unit. Crit Care Nurse. 2013;33(5):56–68.
30.
McDonaghJRElliottTBEngelbergRA. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med. 2004;32(7):1484–1488.
31.
GallagherRKrawczykM. Family members’ perceptions of end-of-life care across diverse locations of care. BMC Palliat Care. 2013;12(1):25.
32.
BillingsJA. The end-of-life family meeting in intensive care part I: indications, outcomes, and family needs. J Palliat Med. 2011;14(9):1042–1050.
33.
LeipzigRMGranvilleLSimpsonDAndersonMBSauvignéKSorianoRP. Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Acad Med. 2009;84(5):604–610.
34.
AngusSVuTRHalvorsenAJ. What skills should new internal medicine interns have in July? A national survey of internal medicine residency program directors. Acad Med. 2014;89(3):432–435.
35.
ArnoldRBillingsJABlockSD. Hospice and Palliative Medicine Core Competencies Version 2.3. Chicago, IL: American Academy of Hospice and Palliative Medicine; 2009.
36.
MaguirePPitceathlyC. Key communication skills and how to acquire them. BMJ. 2002;325(7366):697–700.
37.
BagatellRMeyerRHerronSBergerAVillarR. When children die: a seminar series for pediatric residents. Pediatrics. 2002;110(2 pt 1):348–353.
GlarePVirikKJonesM. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003;327(7408):195–198.
41.
ChristakisNAIwashynaTJ. Attitude and self-reported practice regarding prognostication in a national sample of internists. Arch Intern Med. 1998;158(21):2389–2395.
42.
CurtisJRCiechanowskiPSDowneyL. Development and evaluation of an interprofessional communication intervention to improve family outcomes in the ICU. Contemp Clin Trials. 2012;33(6):1245–1254.
43.
PuntilloKAMcAdamJL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med. 2006;34(11):S332–S340.
