Table 2.

Barriers to Communication Regarding Prognosis

Logistics
Surgical team rounds before the family is present
Cannot assemble entire team (ICU doctors, surgeons, nurses)
Not all parties (ICU doctors, surgeons, nurses) present when meetings do occur
Other support resources not always available (social work, pastoral care, palliative care)
Not enough time during meeting
Poor availability of doctors or family for a meeting
Multiple decision makers in a family
Surrogate decision maker not at the meeting
Meetings interrupted by health care provider pagers and/or cell phone calls
Lack of unbiased person
Patient cannot participate in conversations
Unclear what prior specialists and consultants have said regarding prognosis

Discomfort with discussion
Physician discussions with nurses and families are inconclusive
Family members do not want to “hear bad news” and avoid the meeting
Prognoses are unrealistic and often portray “small victories” instead of overall prognosis
Unclear whose role it is to discuss prognosis and no one ends up doing so
Poorly defined goals of care, even prior to surgery – for surgeon and patient

Perceived lack of skill or training
Physician discussions are rushed
Families are not given adequate time to ask questions
Communication is done “last minute,” often before a procedure
Families are unaware of a patient's diagnosis
There is no accepted protocol about when and what to communicate
If families do not ask for meetings, they will not receive them
Physicians both use language that the family do not understand and do not recognize it
Families do not remember to ask all their questions
Families do not know what resources are available to them
Fear of legal ramifications of bad outcomes

Fear of conflict
Different opinions about prognosis between care providers
Inconsistencies between team members in communicating prognosis to families
Surgery and ICU teams rarely discuss prognosis but get angry when nurses discuss it
Difficult personalities of some health care providers