Interprofessional Teamwork During Family Meetings in the Pediatric Cardiac Intensive Care Unit.

Abstract

CONTEXT\nParents of children in the pediatric cardiac intensive care unit (CICU) report inadequate communication and a lack of empathy during conversations with their clinicians.\n\n\nOBJECTIVE\nTo assess quantitatively and qualitatively the contributions made by team members of different professions in communicating with parents during family meetings.\n\n\nMETHODS\nProspective observational study. The study was conducted in the pediatric CICU at the Children s Hospital of Philadelphia. Subjects were members of the interprofessional team attending family meetings for patients admitted to the CICU longer than two weeks. We used quantitative conversation attribution and coding to compare durations of attendee contributions and contribution type by professional role. The SCOPE codebook and other quantitative codes drawn from best practices in family meetings were used to measure communication behaviors. A qualitative analysis of nurses and social workers contributions was used to identify themes not otherwise captured.\n\n\nRESULTS\nAcross 10 meetings, physicians spoke for an average of 78.1% (SD 10.7%) of each meeting, nonphysicians 9.6% (SD 7.8%), and parents 17.4% (SD 12.2%). Parental understanding was assessed an average of 0.2 (SD 0.4) times per meeting. Parents expressed emotion an average of 4.2 times per meeting (SD 7.1), and the clinical team responded empathetically 2.2 times per meeting (SD 4.3). All clinician empathic responses were a minority of their overall contributions. Conversation was almost exclusively between physicians and families until physicians indicated other team members could contribute.\n\n\nCONCLUSIONS\nCoordination of team members roles in the meetings may improve parental engagement necessary for decision-making and empathic responses that are often missed.