Speaking a Different Language: A Qualitative Analysis Comparing Language of Palliative Care and Pediatric Intensive Care Unit Physicians.
BACKGROUND
Family conferences in the pediatric intensive care unit (ICU) often include palliative care (PC) providers. We do not know how ICU communication differs when the PC team is present.


OBJECTIVE
To compare language used by PC team and ICU physicians during family conferences.


METHODS
A retrospective cohort review of ICU family conferences with and without the PC team.


METHODS
Forty-four bed pediatric ICU in a tertiary medical center.


METHODS
Nine ICU physicians and 4 PC providers who participated in 18 audio-recorded family conferences.


RESULTS
Of the 9 transcripts without the PC team, we identified 526 ICU physician statements, generating 10 thematic categories. The most common themes were giving medical information and discussing medical options. Themes unique to ICU physicians included statements of hopelessness, insensitivity, and "health-care provider challenges." Among the 9 transcripts with the PC team, there were 280 statements, generating 10 thematic categories. Most commonly, the PC team offered statements of support, giving medical information, and quality of life. Both teams promoted family engagement by soliciting questions; however, the PC team was more likely to use open-ended questions, offer support, and discuss quality of life.


CONCLUSIONS
Pediatric ICU physicians spend more time giving medical information, whereas the PC team more commonly offers emotional support. The addition of the PC team to ICU family conferences may provide a balanced approach to communication.
1 Division of Critical Care Medicine, Children's National Health Systems, Washington, DC, USA.
Anne G
AG
Ciriello
1 Division of Critical Care Medicine, Children's National Health Systems, Washington, DC, USA.
Zoelle B
ZB
Dizon
1 Division of Critical Care Medicine, Children's National Health Systems, Washington, DC, USA.|2 Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
Tessie W
TW
October
D002675:Child, Preschool; D003142:Communication; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007802:Language; D008297:Male; D010166:Palliative Care / Q000523:psychology; D065126:Palliative Medicine; D000072143:Pediatricians; D011368:Professional-Family Relations; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology
child; critical illness; decision-making; health communication; palliative medicine; qualitative; social support