COMUNICAÇÃO DE MÁS NOTÍCIAS NA UNIDADE DE TERAPIA INTENSIVA: UM DESAFIO DA EQUIPE MULTIPROFISSIONAL
REGISTRO DOI: 10.5281/zenodo.10036911
Rodrigo Marques Barreto Da Costa1
Dhamacynho César de Lima Peres2
Kassy Jhones Moreira Ferreira3
Ana Carolina Aguirres Braga4
Yasmin Figueiredo da Silva5
Francisca Lucilene Rocha dos Santos6
Matheus Fellipe Alves Justo7
Rosivalda Ferreira de Oliveira8
Lucas dos Anjos Sena9
Állef Diego Bonfim de Andrade10
ABSTRACT
Introduction: Communicating unfavorable news in intensive care units (ICUs) presents a significant challenge for multiprofessional healthcare teams. Hence, research on the complexity of this process and the impacts that may result from how bad news is conveyed to patients and their families is essential. The multiprofessional approach and collaboration among various healthcare professionals play a crucial role in the effectiveness of communicating this sensitive information. In this challenging context, the quality of communication can directly influence the patient’s experience and clinical decision-making, making research and reflection on this topic extremely relevant. Objectives: To identify and discuss the main practices and approaches of the multiprofessional team in communicating bad news to palliative care patients in the Intensive Care Unit. Methodology: An Integrative Literature Review was conducted using the PubMed, BVS, and Web Of Science databases. The research question was: “(Population) In high-complexity healthcare professionals (Intervention) promoting palliative care services in ICUs (Outcomes), what are the challenges in communicating bad news?” The descriptors used were “communication” OR “Communicating bad news” AND “intensive care unit” AND “palliative care.” Articles published between 2018 and 2023 were included in English, with exclusion criteria focusing on articles lacking the research terms in their titles or abstracts and those not addressing the central issue of the article. Results: The study on communicating bad news in the intensive care unit reveals multifaceted challenges, including time constraints, emotional burden, and information complexity. Interprofessional cooperation encounters frequent barriers, with communication strongly affecting the stress and anxiety experienced by patients’ families. The discussion emphasizes the need for training, team integration, and family support, underscoring the importance of future research to enhance communication in these difficult situations. Conclusion: This study underscores the importance of addressing obstacles such as time constraints, emotional burden, and information complexity. Interprofessional collaboration faces difficulties, and the quality of communication directly impacts the well-being of patients’ families. Investing in training, team integration, and family support is critical. Future research is necessary to improve the communication of bad news in the ICU, enhancing the patient experience and clinical decision-making.
Keywords: Communication. Bad News. Intensive Care Unit. Healthcare professional.
RESUMO
Introdução: A comunicação de notícias desfavoráveis em unidades de terapia intensiva (UTI) representa um desafio significativo para as equipes multiprofissionais de saúde, por esse motivo pesquisas sobre a complexidade desse processo e os impactos que podem resultar da forma como as más notícias são transmitidas aos pacientes e seus familiares. A abordagem multiprofissional e a colaboração entre diversos profissionais de saúde desempenham um papel crucial na eficácia da comunicação dessas notícias sensíveis, e este estudo explora as práticas e estratégias adotadas por equipes de UTI para aprimorar esse aspecto crítico do cuidado intensivo. Neste contexto desafiador, a qualidade da comunicação pode influenciar diretamente a experiência do paciente e a tomada de decisões clínicas, tornando a pesquisa e a reflexão sobre esse tópico de extrema relevância. Objetivos: identificar e discutir as principais práticas e abordagens da equipe multiprofissional na comunicação de más notícias sobre pacientes em cuidados paliativos na Unidade de Terapia Intensiva. Metodologia: Foi feita Revisão Integrativa da Literatura realizada nas bases de dados PubMed, BVS e Web Of Science. A pergunta de investigação foi: “(Population) Em profissionais de serviços de saúde de alta complexidade (Intervention) que promovem serviços de cuidados paliativos na UTIs (Outcomes) quais são os desafios para comunicação de más notícias?” Os descritores utilizados foram: “communication” OR “Communicating bad news” AND “intensive care unit” AND “palliative care”. Foram incluídos em inglês dando privilégio aos artigos publicados entre 2018 e 2023. Critérios de exclusão: artigos que não tivessem os termos de pesquisas no título ou nos resumos e artigos sem foco na problemática central do artigo. Resultados: O estudo sobre a comunicação de notícias ruins na unidade de terapia intensiva revela desafios multifacetados, incluindo obstáculos de tempo, carga emocional e complexidade das informações. A cooperação interprofissional é problemática, com barreiras frequentes. A comunicação impacta fortemente as famílias dos pacientes, gerando estresse e ansiedade. A discussão aponta para a necessidade de treinamento, integração de equipes e atenção às famílias, destacando a importância de pesquisas futuras para melhorar a comunicação nessas situações difíceis. Conclusão: Este estudo destaca a importância de enfrentar obstáculos como a falta de tempo, a carga emocional e a complexidade das informações. A colaboração entre profissionais de saúde enfrenta dificuldades, e a qualidade da comunicação influencia o bem-estar das famílias dos pacientes. Investir em treinamento, integração de equipes e suporte às famílias é crucial. Pesquisas futuras são necessárias para aprimorar a comunicação de más notícias na UTI, melhorando a experiência do paciente e as decisões clínicas.
Palavras-chave: Comunicação. Más Notícias. Unidade de Terapia Intensiva. Profissionais de Saúde.
Introduction
The role of the multi professional team plays a fundamental role in the Intensive Care Unit (ICU) in the context of providing palliative care (PC) (1,2).
This multi professional team can be composed of doctors, nurses, physiotherapists, nutritionists, psychologists, social workers, and other healthcare team members, collaborating together to provide symptom relief, discomfort management, emotional support, and an improvement in the quality of life for end-of-life patients(3).
The multiprofessional approach aims not only at managing clinical aspects but also at addressing the biopsychosocial needs of patients and providing comprehensive care to their families. This comprehensive assistance can offer a dignified end-of-life experience for intensive care patients while simultaneously promoting the well-being of their families during this emotionally vulnerable time(4,5).
In this context, the justification and relevance of this research lie in identifying the obstacles that may arise in communicating bad news and examining how collaboration among healthcare professionals can be optimized to overcome these challenges. By specifically addressing this issue, we aim to develop effective strategies not only to enhance clinical practice in delivering bad news but also to improve the quality of services provided to the studied population, offering more comprehensive and compassionate palliative care.
Therefore, the following study had the guiding question: Do healthcare professionals in high-complexity services that promote palliative care in ICUs face challenges and barriers in communicating bad news? Thus, the objective of this research was to identify and discuss the main practices and approaches of the multiprofessional team in communicating bad news about patients in palliative care in the Intensive Care Unit.
Methodology
This is an integrative literature review (ILR) that formulated an initial question following the PICO strategy, in this specific case, PI(C)O. (6): “(Population) Healthcare professionals providing high-complexity care (Intervention) and offering palliative care in ICUs (Outcomes) what are the challenges in communicating bad news?”
The literature search was conducted in the PubMed, BVS, and Web of Science databases. The following keywords were used: “Communication” OR “Communicating bad news” AND “Intensive care unit” AND “Palliative care”.
The search for studies was conducted in journals available from 2018 to 2023, and studies found in English were included. The types of studies included were meta-analyses, randomized and non-randomized clinical trials, scoping and systematic reviews, and case reports that were published and indexed in the aforementioned databases.
The exclusion criteria involved the exclusion of studies that included patients under 18 years of age, articles that did not contain the search terms in their titles, abstracts, or full texts, as well as those that were not freely accessible. Articles that did not directly relate to the focused question were also rejected.
Initially, 642 articles were found, after applying the criteria mentioned above and a floating reading, 26 were selected, of which they were read in full, resulting in a final result of 7 articles, through critical assessment and syntheses of knowledge. In this way, these articles constituted the substrate for the elaboration of this ILR, as outlined in Figure 1 according to the PRISMA(7) Flow Diagram.
Figure 1: Prisma Flow Diagram
Source: the authors, (2023).
Two reviewers used a database developed by the Joanna Briggs Institute (JBI) (6) to extract data from articles included in RIL. Data were collected covering the authors, the year of publication, the type of study, the objectives of the articles, the critical evaluation carried out and the main results important to the issue addressed in our ILR.
To ensure a thorough evaluation of each source of evidence, critical evaluation tools were applied, ensuring a critical analysis of each selected article in terms of its reliability, relevance and presentation of results in the studies.
Results
The selection of articles for this research consists of seven publications that meet the previously established eligibility criteria. These criteria were defined to ensure that these articles adequately answered the research question at hand listed in TABLE 1.
Table 1. Distribution of studies based on authors, type of study and objectives.
| Author/year | Type Of Study | Article Title | Goals |
| Tzenalis et. al. 2023 | Descriptive quantitative research | End-of-life Care in the Intensive Care Unit and Nursing Roles in Communicating with Families | To evaluate the professional attitude of nurses in relation to the care of families of critically ill patients in the ICU, identifying specific attitudes and relating them to their demographic and professional characteristics, with the purpose of drawing conclusions aimed at improving the quality of end-of-term care. life. |
| Kennedy et. al. 2021 | Qualitative research | Perspectives on Telephone and Video Communication in the Intensive Care Unit during COVID-19 | Explore the experiences, perspectives, and attitudes of family members and ICU clinicians about phone and video interactions during hospital visitor restrictions due to COVID-19. |
| Landa-Ramírez et. al. 2021 | Narrative Review | Communicating bad news in the context of COVID-19 | Address the communication of bad news, one of the most frequent activities in hospitals, adapting existing recommendations to meet the needs of the COVID-19 disease context. |
| Maritz & Pathak 2021 | Narrative Review | Palliative medicine in intensive care unit during a pandemic | Examine how the practice of palliative medicine has adapted to the challenges of the COVID-19 pandemic and changes in safety policies that have affected the care of patients and families in the intensive care unit. |
| Paré et. al. 2021 | Mixed Methods Research | Family Perceptions of Palliative Care and Communication in the Surgical Intensive Care Unit | To assess families’ perceptions regarding communication and palliative care in the surgical intensive care unit, as well as examine general care and communication preferences. |
| Seaman et. al. 2022 | Qualitative research | Intensive Care Unit Clinicians’ Perspectives on Achieving Proactive Interprofessional Family Meetings | Explore and understand the practices, barriers, and facilitators related to family meetings in the intensive care unit setting. |
| Ryan et. al. 2022 | Systematic review | Interventions for interpersonal communication about end-of-life care between health practitioners and affected people | Assess the effects of interventions designed to improve verbal interpersonal communication about end-of-life care among healthcare professionals and affected people under palliative care |
Fonte: os autores, (2023).
Discussão
The common objective of all articles is to evaluate or explore different aspects of communication and care in the context of healthcare, especially in critical situations such as intensive care units (ICUs) and palliative care. Each article addresses a specific aspect of communication and care, including assessment of professional attitudes, family and clinician experiences, adaptations to the COVID-19 pandemic, palliative medicine practices, and interventions to improve interpersonal communication. In summary, all articles aim to improve the quality of communication and healthcare in challenging contexts.
In the 3 qualitative research (8–10) seek to explore the experiences, perspectives and attitudes of different interest groups, such as family members, ICU clinicians and healthcare professionals, and investigate practices, barriers and facilitators related to family gatherings, communication during visitor restrictions due to COVID-19. 19 and general perceptions of communication and care. Although they address different aspects of health communication, these studies are united by the common goal of improving the quality of communication and care in critical and challenging clinical contexts.
The only quantitative study (11) sought to evaluate the attitude of nurses in the ICU in relation to the care of families of critically ill patients, with direct implications for the communication of bad news and the quality of care at the end of life. The result was that empathy and communication skills are essential to support families during difficult times, contributing to better quality assistance.
In two narrative reviews (12,13) both lead us to reflect on the importance of adapting bad news reporting and palliative medicine practices to the challenges posed by the COVID-19 pandemic. The ability to provide sensitive information and emotional support in critical healthcare contexts becomes even more crucial during public health crises, highlighting the need to adjust and enhance traditional approaches to meet the emerging needs of patients and their families.
Finally, in a systematic review published in Cochrane(14), the authors highlight the need for future research that fills the gaps, especially considering populations that have not yet been studied in clinical trials. Furthermore, they emphasize the importance of developing sensitive outcome measures to assess the effects of communication in the end-of-life context, considering all parties involved. The authors suggest that mixed and/or qualitative research can provide valuable insights to understand the complex interplay between the different parties involved in communication and inform the development of more effective interventions and appropriate outcome measures.
Conclusion
The objectives achieved by the articles include assessing the professional attitudes of ICU nurses toward caring for families of critically ill patients, exploring the experiences and perspectives of family members and ICU clinicians, adapting bad news reporting practices, and palliative medicine in the face of the challenges posed by the COVID-19 pandemic, the assessment of families’ perceptions about communication and palliative care in the ICU, and the assessment of the effects of interventions designed to improve interpersonal communication about end-of-life care.
The studies analyzed lead us to reflect on the critical importance of health communication in challenging contexts, such as intensive care units and palliative care. The quality of communication plays a fundamental role in improving healthcare and supporting families at critical times. Furthermore, the COVID-19 pandemic has highlighted the need for adaptation and innovation in bad news reporting and palliative medicine practices to meet the emerging needs of patients and their families.
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1 Graduando em Fisioterapia pelo Centro Universitário Integrado (CEI), r.barretoo@outlook.com
2 Fisioterapeuta pela Faculdade Barão do Rio Branco (UNINORTE), Pós-graduado em Ortopedia pela Faculdade Inspirar (INSPIRAR), Fisioterapeuta da Secretaria de Estado de Saúde do Acre (SESACRE), cesarperees@gmail.com
3Graduando em Medicina pela Universidade Federal de Campina Grande (UFCG) Campus Cajazeiras, jhoneskassy@gmail.com
4 Graduada em Fisioterapia pela Universidade Federal de Mato Grosso do Sul (UFMS) e Pós-graduanda em Terapia Intensiva Neonatal e Pediátrica pela Pontifícia Universidade Católica do Paraná (PUCPR/ARTMED) sr.aguirres@gmail.com
5 Graduada em Enfermagem pela Universidade Federal da Paraíba (UFPB), yaahfigueiredo2@gmail.com
6 Graduada em Fisioterapia pela Universidade de Cuiabá (UNIC) e Pós-graduada em Terapia Intensiva Adulto, Neonatal e Pediátrica pela Faculdade Inspirar (INSPIRAR) lurodrigues26@hotmail.com
7 Graduando em Fisioterapia pela Universidade do Estado de Minas Gerais (UEMG), matheushtv@gmail.com
8 Graduada em Enfermagem pela Escola Superior da Amazônia (ESAMAZ), Pós-graduada em Terapia Intensiva (ESAMAZ), Pós-Graduação em Gestão em Enfermagem (UNIFESP), Mestre pelo Programa de Mestrado Profissional em Tecnologia e Inovação em Enfermagem (EERP/USP/UEPA) enf.rosa.oliveira@gmail.com
9 Graduado em Fisioterapia pela da Universidade Federal de Juiz de Fora (UFJF), Pós-graduado em Fisioterapia em Terapia Intensiva Adulto (UNICOR) e Mestrando em Ciências da Reabilitação e Desempenho Físico Funcional (UFJF) fisio.lucassena@gmail.com
10 Graduado em Fisioterapia pela Faculdade São Paulo (FSP), Pós-graduado em Docência do Ensino Superior (UNINTER), Residência Multiprofissional em Fisioterapia em Unidade de Terapia Intensiva (HRC), Mestre em Fisioterapia com ênfase em Cardiorrespiratória (UDESC), Doutorando em Ciências do Movimento Humano (UDESC) allefdiego_bonfim@hotmail.com