“What I’ve been interested in for a few years is dealing with some of the problems that patients and their families face in a situation of critical illness or after they leave the ICU,” says Christopher Cox, MD, MPH, associate professor of medicine (Pulmonary, Allergy and Critical Care Medicine). “Aside from a severe illness, there is difficulty in decision-making and end-of-life care, and the data show that, as doctors, our communication skills are often not stellar. These limitations translate into long-term psychological problems for families, as well as a short-term concern that we may not lead families to the treatment plan that’s best aligned with what the patient values and believes.”
In one project, Cox and colleagues have developed a web-based aid to assist families in making decisions when their loved ones are on life support. The touchscreen program allows patients, families, and doctors to contribute and share information in the same virtual place. The goal is to have a single tool that helps patients understand the clinical situation and treatment goals, and that helps doctors understand the values and priorities of the family.
“We use it as a focal point for our family meetings,” Cox says, noting that so far, the feedback from patients and doctors is excellent. The program is being tested at Duke, the University of Washington in Seattle, the University of Pittsburgh, and UNC-Chapel Hill with funding from the National Institutes of Health.
A couple of other projects focus on the time after patients leave the ICU. “Probably 50-60% of people — and family members too — have symptoms of anxiety, depression, or post traumatic stress syndrome even a year after a critical illness,” he says. To address this concern, Cox and others are partnering with Duke’s psychology department to teach patients active coping skills via telephone and computer during the months following an ICU stay. The program is being tested through a randomized study funded by PCORI (Patient Centered Outcomes Research Institute) and carried out at Duke, UW-Seattle, the University of Pittsburgh, and UNC-Chapel Hill.
A third study, in collaboration with Duke’s psychology department and Duke Integrative Medicine, aims to teach patients mindfulness techniques via phone and video. More information about all these projects can be found at www.dukeprosper.org.