Work

Conflict in intensive care units: a conceptual framework for patient, family, team, and inter-service disagreement

Year: 2026

Type: article

Abstract: For clinicians, conflict in the intensive care unit (ICU) is both common and expected owing to the nature of critical illness and its treatment. Examination of conflict in this context has been conceptually diffuse. Studies of moral distress, psychological safety, ethical climate, and other fields offer valuable insights that can be challenging to synthesize cohesively, due to differences in concepts, methods, and disciplinary perspectives. This narrative review integrates this literature using a task-process-relationship framework from organizational psychology. Conflict in the ICU arises in two principal arenas: between clinical teams and patients, families, or surrogates, and within and across clinical teams. Patients who retain decision-making capacity are a distinct and often overlooked party to conflict, as the focus has primarily been on the families and surrogates who speak for those who cannot. The task-process-relationship framework suggests a recurring escalation pattern for both arenas. Genuine task disagreements about treatment, prognosis, or goals of care can become destructive in the presence of process gaps or failures. These include role ambiguity, inconsistent messaging, and perceived unfairness. From there, conflict can enter the relationship domain wherein mistrust or identity threat makes resolution far harder, and two implications follow. First, much of what clinicians may describe as a "difficult family" can often be a response to antecedent process failures rather than a purely interpersonal problem, emphasizing the importance of engineering robust processes and systems in the ICU to avoid conflict reaching the relationship domain. Second, family and team conflict are linked in that unresolved team disagreement can reach families as contradictory recommendations and mixed messaging. Challenging family situations can expose team misalignment and damage collegial relationships. Evidence-based interventions, organized by conflict type and escalation stage, suggest that the most promising investments are structural, namely those built into rounds, improving role clarity, ensuring pre-conference team alignment, and fostering ethical climate. When conflict becomes entrenched, formal supports such as mediation and ethics consultation are matched to the nature of the dispute. While disagreement in intensive care is inevitable, destructive conflict is not.

Source: Critical Care

DOI: 10.1186/s13054-026-06248-7

Authors: Craig S. Jabaley, Zoe Brummell, Dominique D. Benoit, Nancy Kentish-Barnes, Victoria Metaxa