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Abstract

Introduction: The purpose of this study was to understand communication patterns during PICU family conferences between the medical team and family. Hypothesis: Family conference talk time will be dominated by the medical team compared to family talk time. Methods: Single center, prospective, cross-sectional study of family conferences conducted in the PICU of an urban tertiary medical center. Family conferences between a parent and PICU attending physician to discuss a treatment decision were audio-taped. Results: Ten family conferences were audio-taped, representing 10 unique patients and 5 unique physicians. Three physicians conducted 1 conference, and 2 physicians each conducted 3 conferences. Four conferences discussed goals of care, 3 tracheostomy placement, 3 resuscitation status. Both parents were present in 7/10 (70%) and other family members in 3/10 (30%) conferences. A bedside nurses, a social worker and a consultant physician each were present for 90% of conferences. The mean duration of the family conferences was 37 mins (SD 15 min). The mean family talk time was 6 mins, 25 sec (SD 3 mins, 18% of the total talk time). The mean medical team talk time was 30 mins (SD 12 mins, 81% of total talk time), of which the attending physician spoke for an average of 26 min (87%) and consultants, social workers and other staff spoke for an average of 4 mins (13%). There was full concordance between what the physician leading the conference anticipated discussing and what was subsequently discussed (10/10, 100%). However, the concordance between what was discussed in the conference and what the parents reported was discussed after the conference was full in 3/10 (30%) cases, partial in 5/10 (50%) cases and discordant in 1/10 (10%) cases. Conclusions: The medical team spent significantly more time talking during the PICU family conference as compared to the families. Families understanding of the purpose of the conference frequently did not fully match the content of the conference. Understanding the balance of communication and increasing family involvement in the discussion may improve shared decision-making and family awareness of the topics being discussed. Supported by Grant NIH 5K12HD047349-08