ICUs in 2050: What end-of-life communication challenges await us?
EJRC ARTICLE REVIEW
A paper in the “Intensive care medicine in 2050” article series published in recent months in Intensive Care Medicine, highlights how social and technological evolutions may have an impact on our way of communicating on end of life issues in the future (1).
Benbenishty and Bülow discuss how attitudes and behaviours of future patients and relatives, from the so-called “Millennium Generation” will be modelled by their daily life, in a world where they are always available and informed, and where they have immediate access to any and all information and data. Our own units, which are increasingly becoming more computerised, will be huge data providers, with most of their devices connected and benefiting from diagnostic apps and nano-apps, and from instant and easier exchange of information both inside and outside the ICU. The whole mode of communication, or better to say exchange of information, will be easier and more efficient.
This paper draws a clear picture of the risks and side-effects of this culture, and the overuse of technology; the multiplication of “second opinion” providers, the challenge of computer-assisted exchanges sometimes replacing direct contact with patients, relatives, and staff, reducing real, face to face, exchanges and putting a deleterious distance in circumstances where human contact is essential. Data sharing may easily cross the fragile barriers of confidentiality, spreading information that often should not go beyond the private sphere. Additionally, in this new mode of information exchange, we will also have to integrate differing cultural backgrounds, values and beliefs of patients, relatives and care professionals, and that is difficult to apply to any algorithm. Communicating, in particular in EOL situations, will perhaps demand more time, but also increased listening abilities, empathy, attention and teamwork… skills that we are not yet comfortably proficient (2,3). These abilities can be improved through specific training during, for instance, simulation workshops (2,3).
“Millennials” will be our patients and their relatives in some years; but we are already experiencing the transformations of this new, connected, highly informed world. It is the moment to think how to take the most advantage of the possibilities it offers us; the tools, many of which exist already, and how we move forward to integrate them in a controlled and secure way. Moreover, we must develop strategies to improve communication in and out our ICU, maintain the confidentiality of patients’ information, and focus on sharing mutual understanding, and not only data exchange.
Article review prepared by EJRC member Carole Rocchietti on behalf of the N&AHP Committee.
(1) Benbenishty JS, Bülow HH. Intensive care medicine in 2050: multidisciplinary communication in-/outside ICU? Intensive Care Med doi: 10.1007/s00134-017-4915-9
(2) Zante B, Shefold JC. Teaching End-of-Life Communication in Intensive Care Medicine: Review of the Existing Literature and Implications for Future Curricula. 2017. J Intensive Care Med. 2017 Jan 1:885066617716057. doi: 10.1177/0885066617716057. [Epub ahead of print]
(3) Brezis M et al. What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel. Isr J Health Policy Res. 2017; 6: 48. doi: 10.1186/s13584-017-0169-9. PMC5674237.