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A Systematic Review of Communication Quality Improvement Interventions for Patients with Advanced and Serious Illness |
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| Authors: | Oluwakemi A Fawole MBChB MPH Sydney M Dy MD MSc Renee F Wilson MS Brandyn D Lau MPH Kathryn A Martinez PhD Colleen C Apostol MSN RN Daniela Vollenweider MD Eric B Bass MD MPH Rebecca A Aslakson MD MSc |
| Institution: | 1. Johns Hopkins University Evidence-Based Practice Center, 1830 East Monument Street, Room 8065, Baltimore, MD, 21287, USA 2. Department of Health Policy & Management, Oncology, and Medicine, Johns Hopkins University, Hampton House, Room 609, 624 N. Broadway, Baltimore, MD, 21205, USA 3. Johns Hopkins University Evidence-Based Practice Center, Hampton House, Room 648, 624 N. Broadway, Baltimore, MD, 21205, USA 4. Evidence-Based Practice Center, Johns Hopkins University, 1830 East Monument Street, Room 8065, Baltimore, MD, 21287, USA 5. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA 6. Duffey Pain and Palliative Care Program, Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD, 21205, USA 7. Division of General Internal Medicine, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD, 21287, USA 8. Johns Hopkins University Evidence-Based Practice Center, Hampton House, Room 680A, 624 N. Broadway, Baltimore, MD, 21205, USA 9. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Meyer 297A, Baltimore, MD, 21287-7294, USA |
| Abstract: | BackgroundEffective communication is an interaction between two or more people that produces a desired effect and is a key element of quality of care for patients with advanced and serious illness and their family members. Suboptimal provider-patient/family communication is common, with negative effects on patient/family-centered outcomes.ObjectivesTo systematically review the evidence for effectiveness of communication-related quality improvement interventions for patients with advanced and serious illness and to explore the effectiveness of consultative and integrative interventions.Data SourcesMEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011 and reference list of eligible articles and reviews.Study Eligibility Criteria, Participants And InterventionsProspective, controlled quality improvement studies in populations with life-limiting or severe life-threatening illness with a primary intervention focus of improving communication with patients and/or families.Study Appraisal and Synthesis MethodsTwo investigators independently screened and abstracted data on patient/family-centered outcomes.ResultsWe included 20 studies; 13 (65 %) were in intensive care. We found four intervention types: (1) family meetings with the usual team (11 studies, 77 % found improvement in healthcare utilization), (2) palliative care teams (5 studies, 50 % found improvement in healthcare utilization), (3) ethics consultation (2 studies, 100 % found improvement in healthcare utilization), and (4) physician-patient communication (2 studies, no significant improvement in healthcare utilization). Among studies addressing the outcomes of patient/family satisfaction, 22 % found improvement; among studies addressing healthcare utilization (e.g., length of stay), 73 % found improvement. Results suggest that consultative interventions, as opposed to integrative ones, may be more effective, but more research is needed.LimitationsStudy heterogeneity did not allow quantitative synthesis.Conclusions and Implications of Key FindingsCommunication in the care of patients with advanced and serious illness can be improved using quality improvement interventions, particularly for healthcare utilization as an outcome. Interventions may be more effective using a consultative approach. |
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