Letter to the Editor
Improvement opportunities for communication in the ICU
Oportunidades de mejora de la comunicación en UCI
Á. Estella
Unidad de Gestión Clínica de Medicina Intensiva, Hospital del SAS de Jerez, Spain
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"apellidos" => "Estella" "email" => array:1 [ 0 => "litoestella@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Medicina Intensiva, Hospital del SAS de Jerez, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oportunidades de mejora de la comunicación en UCI" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I have read with interest the article published by Furqan and Zakaria<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> about the implementation of strategies to improve communication. The authors suggest the participation in ICU communication of a social worker or specialized nursing, even have cited experiences with the incorporation of experts in bioethics to perform this function. In my opinion, I am not clear that such actions necessarily lead to improvements in this area. Studies referenced were performed in a health system with different financing that Spanish model. Benefits with respect to the decrease of the ICU length of stay can be influenced by this factor and by the limitation of support treatment decisions. It is difficult to understand that communication influences ICU length of stay when the primary objective of this process must be different: to respect and to promote the autonomy of the patient and to minimize the anxiety of suffering a serious illness reinforcing the necessary confidence in the relationship of the health team-patient. Effective communication in the ICU is a chronically outstanding issue,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> It is indisputable that training in this field is deficient, communication has to be a skill to acquire in Intensive Care<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> with equal importance among others like management of septic shock or mechanical ventilation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">But I have doubts about whether the inclusion of these professionals actually improves communication in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It seems to me fundamental that the intensivist should lead the information procedure, including nurses, patients and their families in bedside rounds to provide direct dialogue and to reduce the occurrence of miscommunication. The complexity of the treatments established in the ICU, diagnostic tests results, clinical changes and prognosis of the critical patient can hardly be explained by the social worker with more rigour than the intensivist. It should not be a rule that the physician has less communicative capacity than other specialists, rational and emotional elements must be at the same time in the effective communication.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Intensivist must be trained in values, ethical behaviour leads to conquest the trust of his patients and relatives, this conquest is not achieved in a day nor can be obtained alone. It requires time, accompaniment and teamwork with the nursing and other trained professionals.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The era of conscious sedation<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> must lead us to abandon topics about the incapacity of the critically ill patient. Being sick, intubated or receiving invasive treatments is not synonymous of incapacity. When it is not possible to communicate with the patient we will do it with their relatives with special dedication through an assertive, close and coordinated team capable of understanding the emotions that disturb the capacity of decision.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As reported in the article, the variability in communication to critical patients and their relatives is a frequently perceived problem, non-technical skills in ICU are relatively neglected. Not all professionals communicate equally, then it is not only a problem of specialization or training, not even of experience. A more complex and integrative process based on critically ill patient values is required.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">No conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Challenges in the implementation of strategies to increase communication and enhance patient and family centered care in the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. Furqan" 1 => "S. Zakaria" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.01.011" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "365" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28318678" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Half the families of intensive care unit patients experience inadequate communication with physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Azoulay" 1 => "S. Chevret" 2 => "G. Leleu" 3 => "F. Pochard" 4 => "M. Barboteu" 5 => "C. 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Ceraso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2013.04.001" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "519" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23773859" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004200000005/v1_201805290410/S0210569117302310/v1_201805290410/en/main.assets" "Apartado" => array:4 [ "identificador" => "57221" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004200000005/v1_201805290410/S0210569117302310/v1_201805290410/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302310?idApp=WMIE" ]
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