Key messages
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Recognising when intensive care unit (ICU) care is not helping a patient achieve valued goals, and helping that patient and their family embrace achievable goals, related to symptom relief or spiritual fulfilment, are central challenges of critical care in the USA
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Randomised trials of complex communication-focused interventions in the ICU have not shown substantial effects on the long-term mental health symptoms in family members of patients in the ICU, but many of these interventions have resulted in a decreased length of stay, particularly among study participants who die in hospital
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Numerous design and analysis challenges make interpreting trials of interventions that are designed to improve communication between ICU providers, patients, and families difficult
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Clinicians and researchers designing and interpreting studies of communication interventions should be aware of the deep-seated cultural norms and structural aspects of US medical institutions that together contribute to Americans receiving substantially more ICU care during their final month of life than residents of similarly wealthy nations