Communicating about end-of-life care with patients and families in the intensive care unit.

Discussing end-of-life care and death with patients and their families is an extremely important part of providing a good quality care in the intensive care unit (ICU). Although there is little empiric research to guide ICU clinicians in the most effective way to have these conversations, there is a developing literature and experience and an increasing emphasis on making this an important part of the care we provide. Much like other ICU procedures or skills,providing sensitive and effective communication about end-of-life care requires training, practice, and supervision, as well as planning and preparation. Although different clinicians may have different approaches and should change their approach to match the needs of individual patients and their families, this article reviews some of the fundamental components to discussing end-of-life care in the ICU that should be part of the care of patients with life-threatening illnesses in the ICU.