Family conferences in the neonatal ICU: Observation of communication dynamics and contributions

Research output: Contribution to journalArticle

Abstract

Objectives: Clinicians in the neonatal ICU must engage in clear and compassionate communication with families. Empirical, observational studies of neonatal ICU family conferences are needed to develop counseling best practices and to train clinicians in key communication skills. We devised a pilot study to record and analyze how interdisciplinary neonatal ICU clinicians and parents navigate difficult conversations during neonatal ICU family conferences. Design: We prospectively identified and audiotaped a convenience sample of neonatal ICU family conferences about "difficult news." Conversations were analyzed using the Roter interaction analysis system, a quantitative tool for assessing content and quality of patient-provider communication. Setting: An urban academic children s medical center with a 45-bed level IV neonatal ICU. Subjects: Neonatal ICU parents and clinicians. Interventions: None. Measurements and Main Results: We analyzed 19 family conferences that included 31 family members and 23 clinicians. The child s mother was included in all conferences, and a second parent, usually the father, was present in 13 conferences. All but one conference included multiple medical team members. On average, physicians contributed 65% of all dialogue, regardless of who else was present. Over half (56%) of this dialogue involved giving medical information; under 5% of clinician dialogue involved asking questions of the family, and families rarely (5% of dialogue) asked questions. Conversations were longer with the presence of nonphysician clinicians, but this did not increase the amount of dialogue about psychosocial information or increase parent dialogue. Conclusions: We collected a novel repository of audiorecorded neonatal ICU family meetings that offers insights into discussion content and process. These meetings were heavily focused on biomedical information even when interdisciplinary clinicians were present. Clinicians always talked more than parents, and no one asked many questions. Maximizing the participation of interdisciplinary clinicians in neonatal ICU family meetings may require explicit strategies. Methods to increase family engagement should be targeted.

Original languageEnglish (US)
Pages (from-to)223-230
Number of pages8
JournalPediatric Critical Care Medicine
Volume17
Issue number3
DOIs
StatePublished - Mar 23 2016

Fingerprint

Neonatal Intensive Care Units
Communication
Observation
Parents
Practice Guidelines
Fathers
Observational Studies
Counseling
Mothers
Physicians

Keywords

  • Communication
  • Family
  • Interdisciplinary health team
  • Neonatal ICU

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

@article{39bca3d4b99142819cd4673336de901a,
title = "Family conferences in the neonatal ICU: Observation of communication dynamics and contributions",
abstract = "Objectives: Clinicians in the neonatal ICU must engage in clear and compassionate communication with families. Empirical, observational studies of neonatal ICU family conferences are needed to develop counseling best practices and to train clinicians in key communication skills. We devised a pilot study to record and analyze how interdisciplinary neonatal ICU clinicians and parents navigate difficult conversations during neonatal ICU family conferences. Design: We prospectively identified and audiotaped a convenience sample of neonatal ICU family conferences about {"}difficult news.{"} Conversations were analyzed using the Roter interaction analysis system, a quantitative tool for assessing content and quality of patient-provider communication. Setting: An urban academic children s medical center with a 45-bed level IV neonatal ICU. Subjects: Neonatal ICU parents and clinicians. Interventions: None. Measurements and Main Results: We analyzed 19 family conferences that included 31 family members and 23 clinicians. The child s mother was included in all conferences, and a second parent, usually the father, was present in 13 conferences. All but one conference included multiple medical team members. On average, physicians contributed 65{\%} of all dialogue, regardless of who else was present. Over half (56{\%}) of this dialogue involved giving medical information; under 5{\%} of clinician dialogue involved asking questions of the family, and families rarely (5{\%} of dialogue) asked questions. Conversations were longer with the presence of nonphysician clinicians, but this did not increase the amount of dialogue about psychosocial information or increase parent dialogue. Conclusions: We collected a novel repository of audiorecorded neonatal ICU family meetings that offers insights into discussion content and process. These meetings were heavily focused on biomedical information even when interdisciplinary clinicians were present. Clinicians always talked more than parents, and no one asked many questions. Maximizing the participation of interdisciplinary clinicians in neonatal ICU family meetings may require explicit strategies. Methods to increase family engagement should be targeted.",
keywords = "Communication, Family, Interdisciplinary health team, Neonatal ICU",
author = "Renee Boss and Donohue, {Pamela Kimzey} and Larson, {Susan M} and Arnold, {Robert M.} and Debra Roter",
year = "2016",
month = "3",
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pages = "223--230",
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T1 - Family conferences in the neonatal ICU

T2 - Observation of communication dynamics and contributions

AU - Boss, Renee

AU - Donohue, Pamela Kimzey

AU - Larson, Susan M

AU - Arnold, Robert M.

AU - Roter, Debra

PY - 2016/3/23

Y1 - 2016/3/23

N2 - Objectives: Clinicians in the neonatal ICU must engage in clear and compassionate communication with families. Empirical, observational studies of neonatal ICU family conferences are needed to develop counseling best practices and to train clinicians in key communication skills. We devised a pilot study to record and analyze how interdisciplinary neonatal ICU clinicians and parents navigate difficult conversations during neonatal ICU family conferences. Design: We prospectively identified and audiotaped a convenience sample of neonatal ICU family conferences about "difficult news." Conversations were analyzed using the Roter interaction analysis system, a quantitative tool for assessing content and quality of patient-provider communication. Setting: An urban academic children s medical center with a 45-bed level IV neonatal ICU. Subjects: Neonatal ICU parents and clinicians. Interventions: None. Measurements and Main Results: We analyzed 19 family conferences that included 31 family members and 23 clinicians. The child s mother was included in all conferences, and a second parent, usually the father, was present in 13 conferences. All but one conference included multiple medical team members. On average, physicians contributed 65% of all dialogue, regardless of who else was present. Over half (56%) of this dialogue involved giving medical information; under 5% of clinician dialogue involved asking questions of the family, and families rarely (5% of dialogue) asked questions. Conversations were longer with the presence of nonphysician clinicians, but this did not increase the amount of dialogue about psychosocial information or increase parent dialogue. Conclusions: We collected a novel repository of audiorecorded neonatal ICU family meetings that offers insights into discussion content and process. These meetings were heavily focused on biomedical information even when interdisciplinary clinicians were present. Clinicians always talked more than parents, and no one asked many questions. Maximizing the participation of interdisciplinary clinicians in neonatal ICU family meetings may require explicit strategies. Methods to increase family engagement should be targeted.

AB - Objectives: Clinicians in the neonatal ICU must engage in clear and compassionate communication with families. Empirical, observational studies of neonatal ICU family conferences are needed to develop counseling best practices and to train clinicians in key communication skills. We devised a pilot study to record and analyze how interdisciplinary neonatal ICU clinicians and parents navigate difficult conversations during neonatal ICU family conferences. Design: We prospectively identified and audiotaped a convenience sample of neonatal ICU family conferences about "difficult news." Conversations were analyzed using the Roter interaction analysis system, a quantitative tool for assessing content and quality of patient-provider communication. Setting: An urban academic children s medical center with a 45-bed level IV neonatal ICU. Subjects: Neonatal ICU parents and clinicians. Interventions: None. Measurements and Main Results: We analyzed 19 family conferences that included 31 family members and 23 clinicians. The child s mother was included in all conferences, and a second parent, usually the father, was present in 13 conferences. All but one conference included multiple medical team members. On average, physicians contributed 65% of all dialogue, regardless of who else was present. Over half (56%) of this dialogue involved giving medical information; under 5% of clinician dialogue involved asking questions of the family, and families rarely (5% of dialogue) asked questions. Conversations were longer with the presence of nonphysician clinicians, but this did not increase the amount of dialogue about psychosocial information or increase parent dialogue. Conclusions: We collected a novel repository of audiorecorded neonatal ICU family meetings that offers insights into discussion content and process. These meetings were heavily focused on biomedical information even when interdisciplinary clinicians were present. Clinicians always talked more than parents, and no one asked many questions. Maximizing the participation of interdisciplinary clinicians in neonatal ICU family meetings may require explicit strategies. Methods to increase family engagement should be targeted.

KW - Communication

KW - Family

KW - Interdisciplinary health team

KW - Neonatal ICU

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