FFICM Patient Communication Skills 3 — Questions and Answers
Question 1: A patient with severe ARDS is conscious but unable to speak due to an endotracheal tube. She appears to be trying to write something. The correct action is:
- Administer additional sedation to reduce apparent distress
- Provide a pen and pad or whiteboard and allow her to write her message (Correct answer)
- Tell her to rest and that communication can wait until extubation
- Ask the bedside nurse to guess what the patient needs
Correct answer: Provide a pen and pad or whiteboard and allow her to write her message
Providing writing materials is a validated, low-tech AAC method that preserves patient autonomy and addresses immediate communication needs.
Question 2: Surrogates of critically ill patients are most prone to which cognitive bias that can impair shared decision-making?
- Availability bias
- Optimism bias overestimating survival probability (Correct answer)
- Anchoring bias on the admission diagnosis
- Framing effects from how mortality statistics are presented
Correct answer: Optimism bias overestimating survival probability
Surrogates consistently overestimate survival probabilities, which is an optimism bias that clinicians must gently address with clear prognostic information.
Question 3: During a family meeting, the intensivist is speaking for 10 uninterrupted minutes about organ dysfunction. According to best-practice communication research, this approach is problematic because:
- It demonstrates insufficient medical knowledge
- Family members retain information poorly when clinicians dominate speaking time (Correct answer)
- It is too brief for complex ICU discussions
- It does not conform to the SBAR framework
Correct answer: Family members retain information poorly when clinicians dominate speaking time
Research shows families recall only a fraction of information when clinicians speak at length; the VALUE framework recommends families speak more than clinicians.
Question 4: A patient recovering from ICU delirium expresses shame about hallucinations they experienced. The most therapeutic response from the intensivist is:
- Reassure them the hallucinations were caused by medications and are not a sign of mental illness (Correct answer)
- Advise them not to discuss the hallucinations as it may worsen recovery
- Refer immediately to psychiatry without addressing the patient's concerns
- Document the episode and defer to the discharge summary
Correct answer: Reassure them the hallucinations were caused by medications and are not a sign of mental illness
Normalizing ICU delirium by explaining its physiological basis reduces stigma and psychological distress in recovering patients.
Question 5: Which statement best reflects the principle of 'prognostic disclosure calibration' in ICU communication?
- Always provide a precise survival percentage at every family meeting
- Withhold prognosis until the patient's condition is definitively established
- Tailor the amount and detail of prognostic information to what the family wants to know (Correct answer)
- Provide the most pessimistic prognosis to prepare families for the worst outcome
Correct answer: Tailor the amount and detail of prognostic information to what the family wants to know
Calibrated disclosure involves first assessing the family's information preferences and then providing prognostic detail accordingly, respecting individual autonomy.
Question 6: A family requests that the team not tell their elderly relative that she is dying. The most appropriate intensivist response is:
- Honor the family's request unconditionally to maintain trust
- Lie to the patient if directly questioned about her prognosis
- Explore the family's concerns while affirming the patient's right to information if she wishes to know (Correct answer)
- Document the request and follow the family's instructions
Correct answer: Explore the family's concerns while affirming the patient's right to information if she wishes to know
While cultural sensitivity is essential, clinicians have a duty to explore the patient's own wishes and cannot routinely withhold information the patient wants.
Question 7: In the context of ICU communication, the 'ask-tell-ask' technique is primarily used to:
- Obtain informed consent for invasive procedures
- Check understanding, provide information in chunks, and verify comprehension iteratively (Correct answer)
- Structure a handover between nursing shifts
- Elicit a complete medical history from a new patient
Correct answer: Check understanding, provide information in chunks, and verify comprehension iteratively
Ask-Tell-Ask is a teach-back-derived technique that ensures information is understood before progressing, reducing miscommunication in high-stakes family discussions.
FFICM Patient Communication Skills 3
A patient with severe ARDS is conscious but unable to speak due to an endotracheal tube.
She appears to be trying to write something.
The correct action is: