title: Parent Satisfaction With Communication Is Associated With Physician's Patient-Centered Communication Patterns During Family Conferences.
abstract: To evaluate the association between physician's patient-centered communication patterns and parental satisfaction during decision-making family conferences in the PICU.
  
  
  
  Single-site, cross-sectional study.
  
  
  
  Forty-four-bed PICUs in a free-standing children's hospital.
  
  
  
  Sixty-seven English-speaking parents of 39 children who participated in an audiorecorded family conference with 11 critical care attending physicians.
  
  
  
  Thirty-nine family conferences were audiorecorded. Sixty-seven of 77 (92%) eligible parents were enrolled. The conference recordings were coded using the Roter Interaction Analysis System and a Roter Interaction Analysis System-based patient-centeredness score, which quantitatively evaluates the conversations for physician verbal dominance and discussion of psychosocial elements, such as a family's goals and preferences. Higher patient-centeredness scores reflect higher proportionate dialogue focused on psychosocial, lifestyle, and socioemotional topics relative to medically focused talk. Parents completed satisfaction surveys within 24 hours of the conference. Conferences averaged 45 minutes in length (SD, 19 min), during which the medical team contributed 73% of the dialogue compared with parental contribution of 27%. Physicians dominated the medical team, contributing 89% of the team contribution to the dialogue. The majority of physician speech was medically focused (79%). A patient-centeredness score more than 0.75 predicted parental satisfaction (β = 12.05; p < 0.0001), controlling for the length of conference, child severity of illness, parent race, and socioeconomic status. Parent satisfaction was negatively influenced by severity of illness of the patient (β = -4.34; p = 0.0003), controlling for previously mentioned factors in the model.
  
  
  
  Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question asking, and emotional talk, positively influence parent satisfaction despite the child's severity of illness.
authors.affiliation: 1Department of Critical Care Medicine, Children's National Health Systems, Washington, DC. 2Department of Pediatrics, George Washington University School of Medicine, Washington, DC. 3Department of Nursing Research and Quality Outcomes, Children's National Health Systems, Washington, DC. 4Center for Translational Science, Department of Pediatrics, Children's National Health Systems, Washington, DC. 5Department of Epidemiology and Biostatistics, George Washington University School of Medicine, Washington, DC. 6Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Tessie W
authors.initials: TW
authors.lastname: October
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: Jichuan
authors.initials: J
authors.lastname: Wang
authors.forename: Zoelle B
authors.initials: ZB
authors.lastname: Dizon
authors.forename: Yao I
authors.initials: YI
authors.lastname: Cheng
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010290:Parents / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods*; D010549:Personal Satisfaction; D011368:Professional-Family Relations; D011446:Prospective Studies; D012720:Severity of Illness Index