Communication During Pediatric Intensive Care Unit Family Conferences: A Pilot Study of Content, Communication, and Parent Perceptions.
While there is a robust literature describing family conferences (FCs) in adult intensive care units (ICUs), less information exists about FCs in pediatric ICUs (PICUs). We conducted a pilot study to describe the focus of discussion, communication patterns of health care team members (HTMs) and parents, and parents' perspectives about clinician communication during PICU FCs. We analyzed data from 22 video- or audiorecorded PICU FCs and post-FC questionnaire responses from 27 parents involved in 18 FCs. We used the Roter Interaction Analysis System (RIAS) to describe FC dialogue content. Our questionnaire included the validated Communication Assessment Tool (CAT). FCs were focused on care planning (n = 5), decision making (n = 6), and updates (n = 11). Most speech came from HTMs (mean 85%; range, 65-94%). Most HTM utterances involved medical information. Most parent utterances involved asking for explanations. The mean overall CAT score was 4.62 (using a 1-5 scale where 5 represents excellent and 1 poor) with a mean of 73.02% "excellent" responses. Update and care-planning FCs had lower CAT scores compared to decision-making FCs. The lowest scoring CAT items were "Involved me in decisions as much as I wanted," "Talked in terms I could understand," and "Gave me as much information as I wanted." These findings suggest that while health care providers spend most of their time during FCs relaying medical information, more attention should be directed at providing information in an understandable manner. More work is needed to improve communication when decision making is not the main focus of the FC.
a Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics , Northwestern University Feinberg School of Medicine.
Kelly
K
Michelson
b Health Care , American Institutes for Research.
Marla L
ML
Clayman
c Weill Cornell Medical College.
Claire
C
Ryan
d The Buehler Center on Aging, Health & Society, Department of General Internal Medicine and Geriatrics, and Department of Psychiatry and Behavioral Sciences , Northwestern University Feinberg School of Medicine.
Linda
L
Emanuel
e Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics , Northwestern University Feinberg School of Medicine.
Joel
J
Frader
D000328:Adult; D002675:Child, Preschool; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D010290:Parents / Q000523:psychology*; D010347:Patient Care Planning; D010865:Pilot Projects; D011368:Professional-Family Relations; D013727:Terminal Care