Understanding the TALK ICU SURVEY and its Purpose
Effective doctor–patient communication is the cornerstone of compassionate care in the ICU. The TALK ICU SURVEY was designed to assess the knowledge, attitude, and practice (KAP) of communication among ICU trainees across India. By examining how future intensivists convey daily updates, discuss prognoses, and handle end-of-life decisions, the study aims to identify barriers and opportunities for improvement within the critical care ecosystem.
In ICU settings, communication involves multiple stakeholders—physicians, nurses, therapists, and families. The survey notes that family satisfaction often reflects how well clinicians address symptoms, respond to relatives’ needs, and maintain empathy, rather than correlating with objective clinical outcomes. This disconnect underscores the need for structured communication training that aligns source messages with receiver understanding.
Study Design and Methodology
The TALK ICU SURVEY received IEC approval (IEC185/2023) and was conducted online from September 8, 2023, to February 16, 2024. Eligible participants were ICU trainees with more than three months of training and enrolled in various postgraduate critical care programs. The questionnaire explored domains such as daily updates, barriers to counseling, breaking bad news, informed consent, and end-of-life care (EOLC).
Blended methods—binary, multiple-choice, and open-ended questions—allowed for both quantitative insight and qualitative nuance. Trainees’ responses were analyzed using descriptive statistics and content analysis, with the Kalamazoo Communication Checklist guiding the interpretation of counseling strategies. The study also examined the impact of formal communication training on handling medical errors and delivering difficult news.
Key Findings and Trends
Among 146 analyzed responses, formal training in communication was linked to greater comfort in discussing medical errors and breaking bad news. Barriers to effective counseling commonly included the family’s education level, physician burnout, language differences, illness severity, and ICU length of stay. Notably, gender emerged as a perceived barrier by a minority of respondents, signaling the nuanced ways in which interpersonal dynamics influence conversations.
The use of audio-visual counseling tools was variable across institutions, with private hospitals often reporting higher utilization than government centers. End-of-life care policies and code white policies for violence prevention also varied, suggesting a need for broader adoption of structured guidelines across facilities. Informed consent practices revealed that just over half of trainees consistently discussed all potential complications, while a substantial portion tailored information to the procedure type.
Implications for Training and Policy
The TALK ICU SURVEY identifies a clear need for scalable, evidence-based communication training that can be embedded in ICU curricula. Trainees with formal training tended to navigate challenging conversations more effectively, implying that coaching, simulations, and standardized protocols (such as enhanced SIPKES or the S-P-w-ICE-S framework) could bolster family-centered care and reduce moral distress among clinicians.
Policy recommendations include mandating dedicated communication training within critical care fellowships, expanding access to audiovisual counseling, and implementing multidisciplinary rounds that include family input. Given the rise of technology-driven communication and the persistence of ‘Google doctors,’ education should also address information verification, trust-building, and managing expectations in the digital age.
Future Directions
Future studies should track family satisfaction alongside communication KAP to establish robust, patient-centered metrics. Integrating family feedback into assessment tools and pursuing longitudinal evaluations will help measure the real-world impact of training interventions. As India advances its critical care landscape, structured communication training could become as essential as technical proficiency in improving patient and family outcomes.
