Professor Irene Higginson, Director, Cicely Saunders Institute, Head of Department, Professor of Palliative Care and Policy, and Honorary Consultant King’s College Hospital NHS Trust, London, UK.
The Intensive Care Unit (ICU) is a highly challenging environment for patients and families. Patients are normally profoundly ill, making communication very difficult. Things can change very quickly, and there is a lot of information for families to take in. For this reason, it is a place where communication and support can be difficult and often can go wrong. Although recovery is the goal, because of the severity of illness many people in ICU deteriorate and/or die.
Our study, published in the October issue of BMC Medicine, 1 developed and tested a new way to improve the care and communication for patients and their families in the ICU.
The study, funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme, developed a simple assessment and communication tool called PACE – which stands for Psychosocial Assessment and Communication Evaluation. The goal of developing this tool was to improve assessment and communication for all patients in the ICU, both those who may deteriorate and equally those who may recover.
PACE consists of the training programme and an assessment, which is recorded in the person’s clinical record. The training programme involves combined work between the ICU and hospital palliative care team staff. The clinical record within PACE asks for assessment of five aspects of care – family details, social details, preferences, communication and information and any other issues, is completed by the key worker for the patient, usually a nurse within 24 hours of admission.
An initial assessment of PACE examined the views of family members on the ICU. From 213 family members, 78% responded to the survey, two-thirds had PACE completed. Those with PACE, had a significantly higher and better satisfaction with the honesty and consistency of information from staff and with symptom control of patients compared with those without PACE.
ICU staff also found PACE very useful. Ninety-five ICU staff members responded and completed the survey and 89% rated PACE as very or generally useful. Additionally, qualitative interviews with families suggested that PACE helps the staff to get to know the patient and family better, helps them feel that someone listens to them and is interested in them and their wishes, as well as in the purely biomedical aspects of the disease.
PACE now needs to be evaluated more widely and in a comparative, ideally randomised, trial and across other centres. There are similar needs for good communication and psychosocial care, and uncertainty, across health care. So PACE might be helpful in other settings especially hospitals.
1. Higginson I, Koffman J, Hopkins P, Prentice W, Burman R, Leonard S, et al. Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty. BMC Medicine 2013, 11:213. PubMed PMID: doi:10.1186/1741-7015-11-213.
The Cicely Saunders Institute