Characterizing Parent-Clinician Discussions About Critically Ill Infants: Empirical Observation of Real-Time Conversations (S713)

Abstract

•Describe interdisciplinary team communication behaviors in a NICU family meeting.•Describe family communication behaviors in NICU family meetings. Clinicians in the neonatal intensive care unit (NICU) must engage in clear and compassionate communication with families. Developing best practices for counseling, and for training clinicians in key communication skills, are hampered without empirical, observational data about how these conversations unfold. To observe and analyze how interdisciplinary NICU clinicians and parents navigate difficult conversations. We prospectively identified and audiotaped NICU family conferences about “difficult news.” Conversations were analyzed using the Roter Interaction Analysis System (RIAS), a quantitative tool for assessing content and quality of patient-provider communication. Each expressed thought is assigned to 37 mutually exclusive categories which are combined into 10 composite codes for analysis. We analyzed 19 conversations with 31 family members and 23 clinicians. For 11/19, the primary clinician was just meeting the family, although 5/11 infants had been NICU patients for >1 month. Although 18/19 conversations included multiple clinicians, 91% of team dialogue was delivered by one or two clinicians. Clinicians contributed 65% of total dialogue; 56% of that dialogue focused on biomedical information. Parents rarely (5% of dialogue) asked questions about that information; clinicians asked even fewer (3.5% of dialogue) questions of the family. Conversations were longer with the presence of non-physician clinicians, but this did not increase dialogue about psychosocial information or increase parent engagement. To the best of our knowledge, this is the first study that directly observes parent-clinician discussions regarding high risk newborns. Even when interdisciplinary clinicians were present, discussion was heavily focused on biomedical information. Clinicians always talked more than parents, and no one asked many questions. Given this, it is difficult to assess shared understanding about an infant's condition.