Parent Satisfaction With Communication Is Associated With Physician’s Patient-Centered Communication Patterns During Family Conferences*

Abstract

Objective To evaluate the association between physician’s patient-centered communication patterns and parental satisfaction during decision-making family conferences in the pediatric intensive care unit. Design Single-site, cross-sectional study. Setting Forty-four bed pediatric intensive care unit in a free-standing children’s hospital. Participants Sixty-seven English-speaking parents of 39 children who participated in an audio-recorded family conference with 11 critical care attending physicians. Measurements and Main Results Thirty-nine family conferences were audio-recorded. Sixty-seven of 77 (92%) eligible parents enrolled. The conference recordings were coded using the Roter Interaction Analysis System (RIAS) and a RIAS-based patient-centeredness score, which quantitatively evaluates the conversations for physician verbal dominance and discussion of psychosocial elements such as a family’s goals and preferences. Higher patient-centeredness scores reflect higher proportionate dialogue focused on psychosocial, lifestyle and socio-emotional topics relative to medically-focused talk. Parents completed satisfaction surveys within 24-hours of the conference. Conferences averaged 45 minutes in length (SD 19 min), during which the medical team contributed 73% of the dialogue compared to parental contribution of 27%. Physicians dominated the medical team, contributing 89% of the team contribution to the dialogue. The majority of physician speech was medically-focused (79%). A patient-centeredness score ≥0.75 predicted parental satisfaction (β=12.05, p<0.0001), controlling for length of conference, child severity of illness, parent race and socioeconomic status. Parent satisfaction was negatively influenced by severity of illness of the patient (β= −4.34, p=0.0003), controlling for previously mentioned factors in the model. Conclusion Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question-asking and emotional talk, positively influence parent satisfaction despite the child’s severity of illness.

End-of-Life and Bereavement Care in Pediatric Intensive Care Units

“…48 Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question asking, and emotional talk, positively influence parent satisfaction with care independent of the child’s severity of illness. 49 Parents of dying children also desire simple language in lieu of medical jargon. 47 High-quality communication at the end of a child’s life fosters trust between families and medical staff and helps to ensure that the dying child receives the best possible care.…”

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

“…October et. al/ [31] advocate that parent satisfaction is largely associated with patient centered communication patterns during family conferences with the physician. In our study setting, most of the parents were not efficient in understanding English whereas the physician and nurses did not have Arabic as their primary language.…”

Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say*

“…Our primary design was a retrospective review of de-identified transcripts from audio-recorded family-physician conferences in a single center PICU of a tertiary medical center. The audio-recordings were part of a larger study aimed at gaining a baseline understanding of family-physician communication during decision-making conferences (9). Eligible family-physician conferences included formal meetings during weekdays convened to discuss tracheostomy placement.…”