title: Family Conferences in the Neonatal ICU: Observation of Communication Dynamics and Contributions.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  An urban academic children's medical center with a 45-bed level IV neonatal ICU.
  
  
  METHODS
  Neonatal ICU parents and clinicians.
  
  
  METHODS
  None.
  
  
  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 audio-recorded 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.
authors.affiliation: 1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 2Berman Institute of Bioethics, Baltimore, MD. 3Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 5Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boss
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Donohue
authors.forename: Susan M
authors.initials: SM
authors.lastname: Larson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D003142:Communication; D016638:Critical Illness / Q000523:psychology; D003657:Decision Making; D004645:Empathy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010290:Parents / Q000523:psychology; D011368:Professional-Family Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology