Communication During Pediatric Intensive Care Unit Family Conferences: A Pilot Study of Content, Communication, and Parent Perceptions

Abstract

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.

Parent perceptions of the impact of the Paediatric Intensive Care environment on delivery of family-centred care

“…The possibility exists that more frequent exchange of information in the form of participation in family meetings or conferences and daily bedside medical rounds could help to lessen or at least normalize and convey sensitivity to parent uncertainty and in turn, distress related to changes in their child's plan of care. Research on family conferences in the PICU indicates that parent satisfaction with communication increased when providers considered competing demands on parent schedules (Levin et al, 2015), and discussed medical and treatment information in understandable language (Michelson et al, 2017), and in a patient and family-centered, empathetic manner (October et al, 2016). In our study, two of the dyads indicated that family meetings were commonplace to discuss their infant's condition and treatment plan; these families had infants with prolonged stays where the plan of care changed frequently.…”

Exploring family needs in neonatal and pediatric intensive care units at King Khaled Hospital- Jeddah

“…Michelson et. Al [28] reported that the parents with children admitted in PICU are more concerned for seeking explanations and there is a need for relaying information by health care team members in understandable manner. The FN for availability of the health care staff throughout the hospitalized period of the child in a pediatric critical care unit is required to optimize treatment outcome [29].…”

Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial

“…Earlier research on the elderly population, chronic heart disease, and communication focused mostly on end-of-life communication and the delivery of bad news without including analyses about other topics [ 29 , 31 , 32 ]. To our knowledge, no previous research exists regarding the perceptions of PM patients about communication during remote monitoring.…”