End-of-life Communication Research Articles

Continuums of Change in a Competence-Building Initiative Addressing End-of-Life Communication in Swedish Elder Care.

Conversations about values for the end-of-life (EoL) between residents, relatives, and staff may allow EoL preparation and enable value-concordant care, but remain rare in residential care home (RCH) practice. In this article, longitudinal qualitative analysis was used to explore changes in staff discussions about EoL conversations throughout workshop series based on reflection and knowledge exchange to promote EoL communication in RCHs. We identified three overall continuums of change: EoL conversations became perceived as more feasible and valuable; conceptualizations of quality EoL care shifted from being generalizable to acknowledging individual variation; and staff’s role in facilitating EoL communication as a prerequisite for care decision-making was emphasized. Two mechanisms influenced changes: cognitively and emotionally approaching one’s own mortality and shifting perspectives of EoL care. This study adds nuance and details about changes in staff reasoning, and the mechanisms that underlie them, which are important aspects to consider in future EoL competence-building initiatives.

Palliative and End of Life Care Preferences in Adolescents and Young Adults with Heart Failure

Purpose Nearly 14,000 children experience heart failure (HF) related hospitalizations annually in the US. Death occurs in 7% of these cases with costly and invasive interventions being common near the end of life (EOL). Yet, youth with HF are less likely to receive palliative care services compared to other pediatric illness groups, with little research focusing on EOL care needs. This study aimed to describe palliative and EOL care preferences in adolescents and young adults (AYAs) with HF. Methods AYAs (12-24 years) with HF or a significant post-heart transplant complication and a parent were enrolled at a single center. AYA/parent dyads completed the Lyon Family-Centered Advance Care Planning Survey. Standard descriptive statistics were reported. Results 46 patients and 44 parents participated. Patients were 63% male; 76% White. Dilated cardiomyopathy (28%), chemotherapy-related cardiomyopathy (24%), and single ventricle heart disease (17%) were the most common diagnoses. Of patients 18 or over, only 24% had completed a Durable Power of Attorney. The majority of patients (57%) had not discussed their EOL care wishes with anyone. Most AYAs (80%) and parents (93%) desired parental involvement in EOL decisions if critically ill. Fewer AYAs (50%) and parents (57%) desired physician involvement in EOL decisions. Preferred timing for EOL discussions varied with nearly 1/3 stating discussions should occur when there is no chance of cure or survival. A quarter (26%) of AYAs preferred to have EOL discussions before getting too sick. Both AYAs and parents commonly endorsed that conversations about EOL wishes should be initiated by the following people: parent, cardiologist, psychologist/therapist, sibling, family physician. While many patients (37%) reported no barriers to discussing EOL wishes, 39% endorsed discomfort with discussions, and 15% stated their doctor never brings it up. Among participants, 13% of AYAs and 41% of parents perceived patient's heart disease to result in shortened life. Overall, AYAs (72%) and parents (66%) did not find participation in this study to be stressful. Conclusion Most AYAs with HF in this study had clear preferences regarding discussions about their EOL wishes; however, the majority had not discussed their wishes with anyone. Interventions to meet the individualized EOL communication needs of young patients with HF are needed.

124 Perceived Quality of End-Of-Life Communication Provided by Healthcare Professionals Among Frail Older Chinese Patients

Abstract Introduction Better communications among the patient, their family, and healthcare providers can enable a shared understanding on patient’s end-of-life (EOL) care preferences. Discussion about death-related issue however has been thought to be taboo among Chinese people. This study aims to explore perceived quality of EOL communication provided by healthcare professionals (HCPs) among frail older Chinese patients. Method Frail older patients were recruited from a medical ward of a public hospital for a randomized controlled trial of the effectiveness of a nurse-led advance care planning. Participants completed a baseline questionnaire including the 7-item Quality of Communication (QOC) Questionnaire which measures perceived quality of EOL communication provided by HCPs (0 “The worst or none happened” to 10 “The best”). Bivariate analyses examined associated factors of QOC. Results Between December 2018 and January 2020, 105 participants were recruited and have completed the QOC. Their mean age was 80 years old (SD = 7.1), and 74% (n = 78) reported had received some formal education. A total of 95 participants (91%) responded “0” to all the 7 items in QOC (poor QOC group). For individual QOC item, all participants scored “0” in 4 items, 99 scored “0” in Item 1 “Talking about details if you got sicker”, 104 scored “0” in Item 2 “Talking about how long you might have to live”, and 101 scored “0” in Item 7 “Respecting your spiritual or religious beliefs”. Participants with “0” score in QOC reported a significant lower mean level in certainty regarding decision-making in EOL preferences (1.2 ± 1.6 vs. 2.3 ± 1.8, p = 0.039). Conclusion Occurrence of talking about EOL care with frail older Chinese patients by HCPs was rare, and the quality of EOL communication associated with decision-making certainty regarding EOL preferences. Training of initiation of EOL discussions and improve communication skills for HCPs is essential. Funding: RGC, HKSAR, China (PolyU14162617H).

Preparing End-of-Life Talks in Palliative Care: Exploratory Remarks on a Social Process

In this article, we develop an exploratory analysis of some of the interactional strategies developed by palliative care (PC) professionals in order to prepare end-of-life (EoL) talks with patients and their families, namely in the frame of specifically social problem-solving work which they develop on a daily basis. In this sense, our object of analysis is not EoL talks in themselves, but the broader social processes that tend to precede them in PC, that is, all the work both of approaching the patient and his or her family and of coordination within the teams that PC professionals routinely do in order to propitiate EoL talk. In this way, we don’t envisage EoL talks as a conversation between two parties, with a patient on one side and a doctor on the other side, but as a wider social process which relies upon strong and previous professional engagement. The analysis conducted herein was carried out on data collected under the projects ETIC – Managing EoL trajectories in palliative care: a study on the work of healthcare professionals (Ref. PTDC/SOC-SOC/30092/2017) and Building paths towards death: an analysis of everyday work in palliative care (Ref. PTDC/CS-SOC/119621/2010), both financed by the Portuguese Science and Technology Foundation (FCT); in particular the data obtained through 17 months (12 in the first project and 5 in the second one, still in progress) of ethnographic observation carried out at two hospital internment units providing PC in Mainland Portugal and 42 (37 in the first project and 5 in the second one, still in progress) in-depth interviews to professionals in PC – physicians, nurses, and social workers. As main results, we present several theoretical and empirical elements relevant to the analysis of the field of EoL communication in the context of interactions between healthcare professionals, patients and their families. Following earlier studies on the same theme, we show how the work of preparing EoL conversations refers to a broader social process preceding those conversations. We believe that our findings may contribute to elucidating this dimension of the intervention of PC professionals, thus being instrumental for the future definition of systematised guidelines and recommendations in the framework of PC.

Current Status of Advance Care Planning and End-of-life Communication for Patients with Advanced and Metastatic Breast Cancer.

BackgroundAdvance care planning (ACP) is a process that supports adults in understanding and sharing their personal values, life goals, and preferences regarding future medical care. We examined the current status of ACP and end‐of‐life (EOL) communication between oncologists and patients with metastatic breast cancer.Materials and MethodsWe conducted a survey among 41 institutions that specialize in oncology by using an online tool in October 2019. Participants (118 physicians) from 38 institutions completed a 39‐item questionnaire that measured facility type and function; physicians’ background and clinical approach, education about EOL communication, and understanding about ACP; and the current situation of ACP and EOL discussions.ResultsNinety‐eight responses concerning physicians’ engagement in ACP with patients were obtained. Seventy‐one (72%) answered that they had engaged in ACP. Among these, 23 (33%) physicians used a structured format to facilitate the conversation in their institutions, and only 6 (8%) settled triggers or sentinel events for the initiation of ACP. In the multivariable analysis, only the opportunity to learn communication skills was associated with physicians’ engagement with ACP (odds ratio: 2.8, 95% confidence interval: 1.1–7.0). The frequency and timing of communication about ACP and EOL care with patients substantially varied among the oncologists. Communication about patients’ life expectancy was less frequent compared with other topics.ConclusionThe opportunity to improve EOL communication skills promoted physicians’ engagement with ACP among patients with metastatic/advanced breast cancer. However, there were still substantial variabilities in the method, frequency, and timing of ACP and EOL communication among the oncologists.Implications for PracticeThis study found that the opportunity to improve end‐of‐life (EOL) communication skills promoted physicians’ engagement in advance care planning (ACP) among patients with metastatic/advanced breast cancer. All oncologists who treat said patients are encouraged to participate in effective education programs concerning EOL communication skills. In clinical practice, there are substantial variabilities in the method, frequency, and timing of ACP and EOL communication among oncologists. As recommended in several clinical guidelines, the authors suggest a system that identifies patients who require conversations about their care goals, a structured format to facilitate the conversations, and continuous measurement for improving EOL care and treatment.

Long-Term Care Nurses and Their Experiences With Patients' and Families' End-of-Life Preferences: A Focus Group Study.

Long-term care (LTC) nurses are a critical nexus for patient communication and vital to advance care planning due to their professional role and breadth of patient relationships. The current study's aim was to explore the communication strategies Midwestern LTC nurses use to clarify patients' end-of-life (EOL) care preferences. Two focus groups used a phenomenological framework to elucidate the experiences of 14 RNs. Data analysis revealed two themes grounded in time: (a) nurses use time to assess patients' EOL situation and assist patients to discern care options; and (b) nurses educate patients about EOL care, adjust care plans, and develop trusting relationships. Two themes were grounded in clinical experience: (a) nurses become persistent advocates and educators to initiate and sustain EOL communication; and (b) nurses learn consistency in communication, including awareness of patients' nonverbal communication. Nurses shared that EOL communication is never "done"; time frames to assess, educate, and clarify are continuous. [Journal of Gerontological Nursing, 46(12), 23-29.].

Application of social ecological model to Taiwanese end-of-life communication and healthcare planning

<h2>ABSTRACT</h2><h3>Background</h3> Cultural and social backgrounds shape how people regard health, illness and death, and also play a significant role in end-of-life (EOL) decision-making in the face of uncertainty and distress. EOL communication and planning can be complex in a society where families play an important role in decision-making for EOL care in Taiwan. <h3>Aim</h3> This study aimed to identify the significance of cultural, community, interpersonal and individual determinants of EOL communication and healthcare planning. <h3>Methods</h3> A social ecological model was applied to underpin the study. A random sample of 2000 adults aged 20 years or above was selected from the electoral roll in a metropolitan area in southern Taiwan. Adults were told that if they did not wish to participate in the study, they could either return a non-participation form or not complete the questionnaires. Hierarchical multiple regression analyses were used to determine the significance of different societal levels of factors on EOL communication and healthcare planning. <h3>Findings</h3> Four hundred and seventy-four valid questionnaires were returned. Hierarchical multiple regression analyses revealed that the models of modified Measures of Public Preferences (<i>p</i> < .0001) were significant, with 22.7% of variance in facilitation, 81.9% of variance in content and 22.9% of variance in support being explained by variables at cultural, community, interpersonal and intrapersonal levels. The model of Advance Directives Attitude Survey (<i>p</i> < .0001) was significant with 25.6% of variance being explained by variables at cultural, community, interpersonal and intrapersonal levels. <h3>Discussion</h3> This study offers empirical evidence embedded within a social ecological perspective of the significance of cultural, social and contextual factors on individuals' preferences for EOL communication and healthcare planning. <h3>Conclusion</h3> Such information is important to enable health professionals to prepare individuals and their families for dealing with challenges related to EOL communication and healthcare.

Chinese perspective on end-of-life communication: a systematic review

BackgroundPalliative care providers serving Chinese patients lack a culture-specific model of communication, a strong evidence base for this and clear guidance on its application. Thus, providers find it challenging to...

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US–Mexico border region—a qualitative study

ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural...

A Systematic Review of Clinical Interventions Facilitating End-of-Life Communication Between Patients and Family Caregivers.

Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient's medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.

Death and End of Life: Perceptions Throughout The Career About Death, Palliative Care, and Educational Process.

To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out. Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC. Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.

Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit.

Racial and ethnic minority patients receive poorer quality end-of-life (EoL) care compared with white patients. Differences in quality of communication (QOC) with clinicians may contribute to these disparities. We measured differences in satisfaction with communication in the intensive care unit (ICU) by race and ethnicity. This is a cross-sectional survey of family members of patients in ICUs of an academic medical center serving a diverse urban population using The Family Satisfaction with the ICU (FS-ICU) and QOC scales. One hundred surveys were completed (18.8% white, non-Hispanic; 34.4% black, non-Hispanic; 31.3% Hispanic; 15.6% other race/ethnicity). Mean FS-ICU score was 84.2 (standard deviation [SD] 20.5) for white patients, 83.3 (SD 16.2) for black patients, 82.7 (SD 17.8) for Hispanic or Latino patients, and 80.9 (SD 18.8) for patients with other race/ethnicity (Kruskal-Wallis, P = .92). Differences remained insignificant when controlling for patient and respondent characteristics. The QOC scale was not scored due to nonresponse levels on questions about EoL communication. Uniformly high ratings may have been influenced by avoidance of EoL discussion. This study is inconclusive regarding whether QOC influences disparities in EoL care since quality of EoL communication was not captured.

Resident Education in End-of-Life Communication and Management: Assessing Comfort Level to Enhance Competence and Confidence

Our primary objective was to understand residents' baseline comfort with end-of-life (EOL) communication and management and to compare this with their comfort after completion of their surgical intensive care unit (SICU) rotation. We also evaluated the association between prior training with perceived level of comfort with EOL issues, and whether the resident believed in the concept of a "better death." As a quality improvement initiative, we conducted surveys of trainees before and after their rotation in the Yale New Haven Hospital SICU. Prerotation and postrotation surveys were administered to all residents who rotated during the 2016-2017 academic year and the first half of 2017-2018. The survey consisted of 34 questions querying residents on their level of training in EOL care, their comfort with management and discussions in different EOL domains, and their beliefs about what measures would have improved their ability to provide EOL care. Residents surveyed were from general surgery, emergency medicine, or anesthesia departments. Our study demonstrates that there is a significant correlation between resident comfort with EOL communication and experience providing EOL care. However, concepts in medicolegal aspects of palliative care could be taught through formal didactics, and structured training may allow residents the opportunity to reflect on the importance of a "better death."

FAMILY CAREGIVERS’ COMMUNICATION NEEDS AT THE END OF LIFE OF OLDER PATIENTS AT GERIATRIC FACILITIES

Current literature on end-of-life communication (EOLC) between family caregivers (FCs) and health professionals (HPs) lacks reference to FCs’ communication needs and primarily addresses its formal aspects of communication such as offering advance directives. We explored FC’s communication needs and developed a questionnaire to evaluate the quality of EOLC. Interviews were conducted with 152 Israeli FCs of patients from nursing care, skilled nursing care, assisted ventilation, and dementia units within four facilities (nursing homes and geriatric medical centers). Most participants were women (61%), married (78%), and were children of the patients (77%), with a mean age of 57.5 (S.D.=12.01, range: 29-88). Qualitative analysis yielded several themes: FCs’ concerns about the availability and accessibility of all types of HPs, information needs (e.g., the need for regular updates initiated by HPs), FCs’ need for emotional support, and difficulties stemming from differences in language and culture. The need for improved communication in these spheres extended to all stages of hospitalization. Based on these needs, we developed a questionnaire to evaluate the quality of EOLC. Reliability was measured in a different sample, and ranged from Cronbach alpha of .916 (41 items; 41 FCs) to .937 (41 items with discrimination index greater than .3; 78 FCs). Factor analysis yielded factors similar to the themes that emerged from the qualitative analysis. The findings highlight aspects of EOLC between FCs and HPs which should be addressed and improved. Thus, this study is a crucial first step toward improving the quality of care at the end-of-life.

PREPARATION FOR THE END OF LIFE AND PERCEIVED QUALITY OF CARE PRIOR TO HOSPICE REFERRAL: A SURVEY OF CAREGIVERS

Lack of preparation for the end of life (EOL) can lead to poor outcomes for caregivers. The purpose of this study was to learn if perceived quality of EOL care and communication provided by the primary clinician prior to hospice referral is associated with caregivers’ perceived preparedness to deal with medical emergencies/complications at the EOL. We conducted a survey of caregivers of patients who died and were referred to hospice in the prior year. Perceived quality, was measured by the Quality of End of Life Care (QEOLC) scale, and “preparedness” was a binary measure asking if caregivers felt unprepared to deal with medical emergencies and/or complications related to the care of the patient at the EOL. We performed a bivariate analysis using a two-sample t-test to determine if QEOLC scores were greater among those indicating they were prepared compared to those indicating they were not prepared. We received a response rate of over 22.8% (49/215). Mean EOL scale scores were 82.0 (SD=3.8) for those reporting that they did not feel unprepared for medical emergencies/compilations that arose near the EOL, and 68.2 (SD=7.3) for those who reported that they did feel unprepared. Results show that the mean difference approached significance (t=1.85; p=0.07). Although results only approached significance, EOL care from clinicians involved prior to hospice enrollment may be perceived as higher quality among those who felt prepared to handle emergencies/complications. This finding suggests that caregivers highly value early EOL education and communication aiding in preparation for emergencies/complications arising after hospice referral.

End-of-Life Communication Between Providers and Family Caregivers of Home Hospice Patients in a Rural US-Mexico Border Community: Caregivers' Retrospective Perspectives.

Family caregiver-provider communication is essential to making an effective hospice care transition for patients. Despite the importance of this topic, there is little information about how caregivers in rural US-Mexico border regions navigate hospice care transition and their needs. This study explores the family caregivers' experience relating to their end-of-life (EOL) communication and needs for hospice care transition. In-depth interviews using qualitative methods were conducted with 28 informal caregivers of patients who are enrolled in home hospice care in a rural US-Mexico border region. Thematic analysis was applied to analyze the data. Qualitative themes that emerged include (1) lack of/insufficient EOL communication and (2) informational needs, including (a) signs of symptom changes, (b) EOL treatment options and goals of care, and (c) hospice care and its benefits. Limited caregiver-provider EOL communication was observed, in which the majority of the caregivers (n = 22, 78.6%) were informed of the patient's terminal condition, but only half (n = 15, 53.6%) had a discussion with the providers about hospice care. Timely EOL communication between caregivers and the providers is key to the patient's optimal transition to hospice care. Providers need to be aware of the caregivers' informational needs relating to patient symptoms and health condition as well as hospice care. It is important to be aware of the impact of cultural values on hospice care placement. A clear explanation about the purpose and functions of hospice care and its benefit can better guide the family caregivers in making hospice care decisions.

The Acceptability and Feasibility of Using Mortality Prediction Scores for Initiating End-of-Life Goals-of-Care Communication in the Adult Intensive Care Unit

ContextUncertainties in prognosis remain a barrier to end-of-life (EOL) communication in the intensive care unit (ICU), thus strategies are needed for increasing the precision of prognosis and timeliness of EOL goals-of-care communication. Use of mortality prediction scores offers one approach to this issue. ObjectivesThis study evaluated the acceptability and feasibility of providers' use of patient mortality prediction scores as part of routine practice to increase prognosis precision and timeliness of EOL communication as well as providers' intentions to change practice related to EOL goals-of-care communication based on awareness of the scores. MethodsAn explanatory mixed-methods approach was used to provide Sequential Organ Failure Assessment (SOFA) patient mortality prediction scores to ICU providers, who then completed an acceptability and feasibility questionnaire and participated in follow-up interviews conducted to further understand questionnaire responses and gain insight into their perceptions based on having SOFA scores. ResultsProviders reported that using SOFA scores was acceptable and feasible, although there was some disagreement about effectiveness of SOFA scores for determining mortality risk. Providers with limited ICU experience were eager, and accepting of the scores while those with more experience found the scores to be an adjunct to their own intuition, although all acknowledged the benefit of looking at score trends. An important finding was the need to consider SOFA scores in relation to patient clinical context. ConclusionUse of SOFA scores as a means to potentially increase EOL goals-of-care communication emerged as most beneficial and acceptable to providers with limited ICU experience.

Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities: PACE Cross-Sectional Study

ObjectiveTo examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DesignA cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. Settings and participantsA total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). MethodsThe Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. ResultsThe quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = −0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. ConclusionThe quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. ImplicationsLTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.

Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units.

Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments' psychometric properties and determine which best measures family-clinician communication in the ICU. A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician-Family Caregiver Communication, and Quality of Communication (QOC). Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC's convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families' treatment response in randomized control trials. Quality of Communication is the most suitable instrument to measure family's perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family-clinician communication and data about how to improve EOL care in ICUs.

A literature review on end-of-life care among Korean Americans

The increasing population of Korean Americans in the US makes it mandatory to develop and provide culturally competent end-of-life (EOL) care for this population. To synthesize previous studies on Korean Americans and their end-of-life (EOL) care. Four databases (Cinahl, PsycInfo, PubMed, and SocIndex) were searched and 11 articles were selected for review. Korean Americans tend to avoid EOL communication, and instead hope that their families would know about their wishes, without discussing them directly. Korean Americans consider advance directives unnecessary, and only a few Korean Americans use advance directives to lessen the burden of their family's decision-making. Many Korean Americans are unaware of what EOL care provides, which may explain why they seldom use it. Providers should discuss EOL care with Korean Americans and tell them what it entails. However, the discussion should be culturally tailored and involve family members whenever possible.