Patients' families want doctors to talk more

Doctors don't talk enough, and that has to change.

That's the conclusion of a recent study by researchers at the University of San Francisco Medical Center, which found that even when there is little to say or the information is uncertain, the families of critically ill patients want to know as much as they can.

Douglas White, and assistant professor at UCSF's Program in Medical Ethics and lead author of the study, said the families understand that doctors will not always have all the answers.

"Our interviews revealed that caregivers appear to believe that some uncertainty is unavoidable, and just the nature of life. ... The vast majority of families of critically ill patients want physicians to openly discuss the prognosis, even when physicians can't be certain that their estimates are correct."

Previous studies have found that doctors are reluctant to discuss cases with families, particularly when the prognosis is uncertain.

The new stdy, published in the January issue of the American Journal of Respiratory and Critical Care Medicine, is based on face-to-face interviews with 179 family members of patients in four different Intensive Care Units.

Eighty-seven per cent said they would want to be told of all prognostic estimates, even if they were tentative, and most said they appreciated doctors showing candor in discussing uncertain outcomes, White said. More information will help families decide on care, and prepare for whatever happens.

"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process. ...I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."

Doctors, he said, need to learn the skills involved in dealing with families of critically ill patients.