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The views of patients and relatives of what makes a good intensivist: a European survey

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Abstract

Objective

This study examined the views of adult patients and relatives about desirable characteristics of specialists in intensive care medicine (ICM) to incorporate these into an international competency-based training programme, CoBaTrICE.

Design

Convenience sample of patients and relatives administered after discharge from 70 participating ICUs in eight European countries (1,398 evaluable responses). The structured questionnaire included 21 characteristics of medical competence categorised as ‘medical knowledge and skills’, ‘communication with patients’, and ‘communication with relatives’. It was available in the national languages of the countries involved. Questions were rated by respondents for importance using a four-point Likert scale. Responses to open questions were also invited.

Results

Most characteristics were highly rated, with priority given to medical knowledge and skills. Women were more likely to emphasise communication skills. There were no consistent regional differences. Free-text responses welcomed the opportunity to participate.

Conclusions

Patients and relatives with experience of intensive care in different European countries share similar views on the importance of knowledge, skills, decision making and communication in the training of intensive care specialists. These generic patient-centred components of training have been incorporated into the international competency-based ICM training programme, CoBaTrICE.

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Acknowledgements

We acknowledge with gratitude the contribution and support of the ICU directors, medical and nursing staff, patients and their relatives in the participating ICUs, who made this survey possible. Principal authors: Dr. A. Hasman, Dr. J. Askham (Picker Institute Europe); Dr. H.U. Rothen (CoBaTrICE National Coordinator, Switzerland); Dr. P. Berg (Department of Intensive Care Medicine, University Hospital, University of Bern, Switzerland); Dr. J.F. Bion (CoBaTrICE Project lead), H. Reay (CoBaTrICE research nurse) on behalf of the CoBaTrICE Collaboration. Steering Committee Partners: A. Augier; D. d'Hoir (European Society of Intensive Care Medicine); J.F. Bion, H. Reay, J. Lonbay, S. Field, A. Bullock (University of Birmingham); J. Askham, A. Hasman, R. Reeves (Picker Institute Europe); I. Novak (Charles University); A. Kari, P. Mussalo (Intensium Oy). National Coordinators, ICU Directors and ICU Representatives: Czech Republic: V. Sramek (NC), V. Cerny (NCD), R. Parizkova, I. Novak, P. Potuckova, O. Marek, I. Chytra, P. Jiranek, Z. Veleba, C. Adamec, J. Manak; Denmark: E. Rønholm (NC), J.S. Hansen, D. Köhler, B. Rasmussen, A. Poulsen, K. Espersen, K.M. Larsen, K. Martinsen, H. Stougaard, K. Antonsen, N.E. Drenck, E. Peddersen, H. Joensen; Italy: F. Rubulotta and A. Gullo (NC), G. Iapichino, A. Pezzi, C. Anello Belluomo, M.L. Tuccillo, V. Lanza, A. Pigantaro, D. Carmelo, C. Quattrone, G.P. Giron, E. Facco, R. Alvisi, M. Capuzzo, R. De Gaudio, C. Adembri, M. Antonelli, G. Ferro, P. Piccini, N. Zamperetti; The Netherlands: A. van Zanten (NC), A. Girbes (NCD), K. de Blok, M. Petjak, C. Slagt, C. de Ridder, R.A.L. de Waal, J. Leijs, H. Ponssen, H. Joore, E. Smit; Poland: A. Mikstacki (NC), B. Tamowicz, M. Jurkiewicz, W. Gaszyñski, A. Kübler, M. Łukaszewski, A. Nestorowicz, J. Biernacka, L. Drobnik, M. Błaszyk, R. Szulc, A. Pytliński, J. Nadolski, J. Tyczka, D. Maciejewski, E. Łoniewska-Palecnzy, J. Bojko, K. Wojciech; Spain: G. Gonzalez Diaz (NC), P. Monedero (NCD), L. Blanch (NCD), M. del Bañ Aledo, R. Peyro Garcia, G. Gomá, M. Maluenda, J. Blanco Varela, V. Fraile Gutierrez, L.I. Cabré Pericas, G. Carrasco Gómez, M.V. de la Torre-Prados, L. Rucabado Aguilar, J. Garcia Pardo; Switzerland: H.U. Rothen (NC), M. Maggiorini (NCD), P. Berg, C. Jenni, M. Laube, P. Mandorff, D. Ryser, R. Stocker, A. Haller, R. Chiolero, J.-P. Revelly, P. Eckert, R. Lussmann; United Kingdom: K. Gunning (NC), J.F. Bion, S. Desai, J. Hurst, M. Blunt, C. Underwood, B. Appadu, A. Vuylsteke, F. Bottrill, I. Crabb, P. Nightingale, D. Downs, C. Danbury, C. Jones. CoBaTrICE Nominal Group: A. Armaganidis (Greece), U. Bartels (Germany), P. Ferdinande (Belgium), V. Gasparovic (Croatia), C. Gomersall (Hong Kong), S. Iyer (India), A. Larsson (Denmark), M. Parker (United States), J.A. Romand (Switzerland), F. Rubulotta (Italy), J. Scholes (United Kingdom); A. van Zanten (The Netherlands). CoBaTrICE Editorial Working Group: J. Bion (Chair), L. Blanch (Spain), C. Gillbe (United Kingdom), T. Gondos (Hungary), D. Grimaldi (France), T. Kyprianou (Cyprus), D. McAuley (United Kingdom), A. Mikstacki (Poland), I. Novak (Czech Republic), D. Phelan (Ireland), G Ramsey (The Netherlands), E. Ronholm (Denmark), H.U. Rothen (Switzerland). Sponsors: CoBaTrICE is supported by a grant from the European Union, Leonardo da Vinci Programme. Additional supporters: ESICM, SCCM, GlaxoSmithKline, Pfizer (HK), and State Secretariat for Education and Research, Switzerland. This research project is supported by the European Critical Care Research Network (ECCRN) of the European Society of Intensive Care Medicine (ESICM).

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Authors and Affiliations

    Consortia

    The CoBaTrICE Collaboration

    Additional information

    On behalf of The CoBaTrICE Collaboration:

    Hans U. Rothen University Hospital Department of Intensive Care Medicine 3010 Berne, Switzerland e-mail: hrothen@insel.ch Tel.: +41-31-6321176 Fax: +41-31-6329644

    The full list of authors is provided under “Acknowledgements”.

    This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0800-2.

    Electronic supplementary material

    Appendix: Examples of free text comments

    Appendix: Examples of free text comments

    On the theme of medical knowledge and skills, respondents said such things as:

    • They (doctors) should have both knowledge and experience of modern diseases. They should make a right diagnosis fast and be confident and self-controlled in the way they handle themselves in front of patients and relatives—but without talking down to them! (Relative, Poland).

    • Although it is important to involve patients and relatives in the decision-making process, decisions should be based on the presenting evidence and should be informed by experience and expertise. It may thus be appropriate that relatives and patients are informed of decisions rather than fully involved. (Relative, United Kingdom)

    • (Doctors should have) capacity to take responsibility. (Patient, Switzerland)

    On communication with relatives:

    • He (the doctor) has to be clear in the way he informs relatives and all doctors should give the same information. (Relative, Italy)

    • Doctors should remember that contact with relatives is very important. They could find out a lot about the patient and his or her previous illness… . (Relative, Poland)

    • Empathy. A doctor who can empathise with relatives or who encourages his team to be equally caring no matter how busy they are gives so much comfort in these times of distress. (Relative, United Kingdom)

    • Don't always focus on the worst scenario; point out the positive signs too. (Relative, United Kingdom)

    On communication with patients:

    • (Doctors should be) kind, patient and open to working with patients. (Relative, Czech Republic)

    • Never forget I am a human being. (Patient, Italy)

    • (Doctors need to) speak a language that patients can understand. Terms used are often too medical. (Patient, The Netherlands)

    • It is important that they (doctors) give themselves time to talk to patients and relatives. (Patient, Denmark)

    • Listen properly to the patient and let them finish talking. (Patient, The Netherlands)

    On moral qualities underpinning competencies:

    • (Doctors should) keep smiling and be sensitive. It doesn't cost anything but helps a lot. (Relative, Czech Republic)

    • It is important to see the patient as a whole human being not just a symptoms and illness. (Relative, Denmark)

    • (Doctors should have) patience, compassion, sense of humour. (Patient, Spain)

    • Nobody is perfect. Just like anyone else a physician is human… he/she can also make mistakes. If this happens it is important to acknowledge these and discuss them. (Relative, The Netherlands)

    • Ability to treat patient with dignity (Relative, Poland)

    On personal experiences:

    • Saw so many different doctors did not have a clue who they were most of the time … but I stress the care was outstanding. (Relative, UK)

    • Explaining what is going on with the patient has been done well! (Patient, Switzerland)

    • I have noticed an excellent relationship between doctors/staff and family. Availability and humanity are ‘little’ things but in this moment of your life they make the difference. Thank you. (Relative, Italy)

    • Thanks for giving me this chance to express myself. (Relative, Italy)

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    The CoBaTrICE Collaboration. The views of patients and relatives of what makes a good intensivist: a European survey. Intensive Care Med 33, 1913–1920 (2007). https://doi.org/10.1007/s00134-007-0799-4

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