Content area
Full text
Conflict implies opposing forces. In the healthcare setting, patients, their family members, and physicians are ideally aligned in promoting patients' well-being. Therefore, conflicts that arise between physicians and patients or family members regarding patients' goals of care constitute failures of therapeutic alliance, communication, or the shared decisionmaking model (1). In the intensive care unit (ICU), these conflicts may be due, in large part, to lack of agreement on information underlying preference-sensitive decisionmaking, such as whether family members accept the prognostic estimates provided by physicians (2, 3), inadequate understanding of the patient's medical condition or the risks and benefits of therapies, or physicians' ability to communicate this information effectively (4).
The heightened emotional state of those involved in critical care decisionmaking may magnify misunderstandings and communication difficulties. In large part, this is due to predictable changes in cognitive processing when we as human beings are threatened (5), as family members are when facing a loved one's potential mortality, as well as our tendency to demonstrate optimism bias (2). Physicians must acknowledge that these cognitive distortions are not personal shortcomings of family members but rather their behavioral adaptations to stress. Failure to do so creates opposition between those advocating for the patient, resulting in conflict.
Mitigating such conflict is a key skill that ICU physicians should possess to maintain appropriate focus on care that will maximize patients' well-being. In addition, managing conflict well is likely to improve family members' outcomes after involvement in ICU care (6) and decrease the frequency of moral distress and burnout among physicians (7, 8). Such conflictmanagement skills include recognizing potential or actual conflict, avoiding its development, and resolving conflict if it does occur. Yet, all physicians may not possess these skills.
There is little empirical work describing how ICU physicians understand and approach conflict with families. This foundational step would advance the patient- and family-centeredness of ICU care for two reasons. First, this understanding is necessary to develop evidence-based communication practices aimed at decreasing conflict in the ICU. Second, evaluating the extent to which physician behaviors, such as conflict management, vary among ICU physicians will enable the development of effective interventions resulting in undue variation in care patients receive. There are few identified mechanisms for the well-defined variation in critical care delivery...