October 23-29 is Canadian Intensive Care Week. It’s a time to profoundly reflect on the tremendous service our colleagues working in intensive care have rendered to society during the past years of the pandemic and continue to do so under such adverse circumstances. I spent more than 20 years working in the ICU in Kingston and know personally both how meaningful and demanding it can be to care for critically ill patients and support their stressed families. My heartfelt thanks go out to these dedicated colleagues in the trenches!
Intensive care is an important, foundational aspect of our modern health care system. It is the place in the hospital where the sickest of the sickest patients go for monitoring, diagnostic procedures, and treatments with hopes of recovery, or, for intensive support during the final days of life. Some of the most difficult decisions that we (doctors, nurses, patients, and families) will make is whether to access ICU services or, once a patient is in the ICU, whether to continue or not, the life-sustaining treatments.
Be Better Prepared for the ICU
These life and death decisions are difficult. What makes it more difficult for all stakeholders is that, by and large, people are ill-prepared to step into that space of serious illness decision-making. Consequently, doctors and nurses are less likely to engage with patients and families in a comprehensive, educative, time-consuming, and emotionally laden conversation that has life and death consequences. The result, as shown by research evidence, is that patients are often receiving the ‘wrong’ medical care. Plan Well Guide is dedicated to helping with this complex problem.
Here is a list of the resources we’ve developed to help these stakeholders improve communication and decision-making in the context of serious illness:
Resources for the Public
We developed a virtual reality scenario to help people increase their understanding of the nature of serious illness decision-making and find their motivation to do their serious illness planning in advance. This allows them to both see and feel the importance of making these decisions in advance, without a trip to the ICU. To see a 2-D version video of this VR video, you can check out this link.
To help people generally increase their understanding of the nature of critical illness, treatments provided in an ICU, and the possible outcomes of critical illness, we developed the following tools:
- Advance serious illness planning (ASIP), Learning Centre blog library, and CPR Decision Aid Video on Plan Well Guide. Be sure to check out the Must-know Statistics about ICU Care blog in the Learning Centre
- My ICU Guide – a decision support guide for family members of patients in the ICU who are thrust into that role of making life and death decisions on behalf of their loved ones.
- Things to Know Before You Consent to ICU Care 12-Minute Webinar answering all your questions about the ICU.
- Family Satisfaction with the ICU Survey (FSICU) – place for family members of ICU patients to provide feedback to the ICU team how things went from their point of view using a validated questionnaire (The Family Satisfaction with ICU care- 24R).
Resources for Health Care Professionals
- An extensive list communication and decision support tools including conversation guide aimed at helping health care professionals improve their communication and decision-making skills in the context of serious illness can be found on Plan Well Guide.
- Family Satisfaction with the ICU Survey (FSICU) – a place to obtain the best validated questionnaire (The Family Satisfaction with ICU care- 24R) that can be used to systematically collect feedback from families of ICU patients that can be used to guide quality improvement initiatives.
If you are reading this, please engage with some of our resources and provide us with feedback. Consider sharing this blog with others in your circles so we can increase the quality of communication and decision-making related to serious illness.
The goal is that the general public is more prepared when serious illness strikes, health care professionals do a better job collaborating with patients and families to make better decisions (leading to less medical error), and health care system decision-makers build systems that facilitate and reward this high-quality work.
Lastly, don’t forget to hug an ICU professional or send of message of gratitude to them during Canadian Intensive Care Week!
Dr. Daren Heyland
