Overview of the TALK ICU SURVEY
A recent pan-India study examined the knowledge, attitude, and practice (KAP) of communication skills among ICU trainees. The TALK ICU SURVEY was designed to capture how future critical care physicians convey daily updates, discuss prognosis, obtain informed consent, and navigate end-of-life care (EOLC). The goal is to identify barriers to effective doctor–family communication and to propose actionable strategies for standardized training across varied hospital settings in India.
Why ICU Communication Matters
In the intensive care unit, communication is not a luxury—it is a cornerstone of patient- and family-centered care. The source-message-receiver model underpins this process: the physician is the source, the clinical condition is the message, and the family is the receiver. When both sides share a common understanding, anxiety is reduced, trust is built, and decisions about care align with patient values. The TALK ICU SURVEY highlights that most communication skills are learned informally, creating a systemic gap that can contribute to disengagement, distress, and even violence in extreme cases.
Key Findings on Knowledge, Attitude, and Practice
Survey respondents were ICU trainees who had completed at least three months of training. Formal communication training was reported by about half of the participants, while a smaller portion routinely used audiovisual tools for counseling and recorded sessions for educational purposes. Notably, a large majority believed that EOLC policy informed decision-making, but there remained substantial variability in policy exposure across institutions. Trainees with formal communication training demonstrated greater ease in discussing medical errors and delivering bad news, suggesting a strong link between structured education and practical competence.
Barriers to Effective Counseling
Respondents identified several barriers: the education level of family consultees, physician burnout, language differences, severity of illness, and prolonged ICU stays. A minority even cited gender as a potential barrier. These factors collectively hinder the nuanced conversations required during daily updates and more complex EOLC discussions.
Strategies in Daily Counseling
Using the Kalamazoo checklist as a framework, trainees reported partial adoption of core communication behaviors, such as establishing rapport, gathering information, and clarifying perspectives. The SPIKES protocol, a widely taught method for breaking bad news, was mentioned by only a minority, signaling a gap between recommended practice and natural habit in busy ICUs.
Difficulties in Breaking Bad News and Interdisciplinary Conflicts
About 39% of participants reported difficulty in breaking bad news. Contributing factors included aggressive family members, moral distress, and the emotional weight of death declarations. Interdisciplinary conflicts—driven by communication gaps, knowledge gaps, and ego—were common, underscoring the need for formal multidisciplinary training and regular team meetings to harmonize care plans.
The COVID-19 Lens and Policy Implications
The pandemic transformed doctor–family interactions, accelerating telecommunication and the rise of “Google doctors,” which sometimes eroded trust. Ninety-six percent of respondents supported stronger EOLC policies, indicating strong appetite for clearer guidelines that balance clinical realities with patient and family values. India’s ISCCM and IAPC policy statements could serve as a scaffold for standardized curricula and hospital practices.
Training Recommendations and Future Directions
Participants overwhelmingly supported formal communication training, real-time feedback, simulation-based teaching, and the creation of SOPs. The medical education community should expand AETCOM-inspired curricula beyond undergraduate training, embed communication components in residency programs, and mandate structured assessment of family satisfaction alongside clinical outcomes. Implementing audiovisual counseling as a routine practice, with ethics and privacy safeguards, could turn counseling into an observable, teachable skill with measurable impact.
Conclusion
The TALK ICU SURVEY shines a light on critical gaps in ICU communication within India’s diverse healthcare landscape. By prioritizing formal training, multidisciplinary collaboration, and policy-aligned practices, Indian ICUs can move toward a more compassionate, transparent, and effective communication paradigm that benefits patients, families, and healthcare teams alike.
