title: Analysis of enacted difficult conversations in neonatal intensive care.
abstract: OBJECTIVE
  To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care.
  
  
  METHODS
  Physicians, nurses, social workers, and chaplains (n=50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS).
  
  
  RESULTS
  Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD=P<0.005; RN=P<0.05), focused more on family's opinion and understanding (MD=P<0.01; RN=P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support.
  
  
  CONCLUSIONS
  Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.
authors.affiliation: Institute for Professionalism and Ethical Practice, Children's Hospital, Boston, MA, USA. Giulia.lamiani@unimi.it
authors.forename: G
authors.initials: G
authors.lastname: Lamiani
authors.forename: E C
authors.initials: EC
authors.lastname: Meyer
authors.forename: D M
authors.initials: DM
authors.lastname: Browning
authors.forename: D
authors.initials: D
authors.lastname: Brodsky
authors.forename: I D
authors.initials: ID
authors.lastname: Todres
mesh_terms: D000328:Adult; D003142:Communication; D004493:Education; D004645:Empathy; D005066:Euthanasia, Passive / Q000523:psychology*; D022143:Family Nursing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000523:psychology*; D015931:Intensive Care, Neonatal / Q000523:psychology*; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team; D016544:Patient Simulation; D011368:Professional-Family Relations; D012381:Role Playing; D012944:Social Support