Speaking a different language: Communication patterns of palliative care and pediatric intensive care unit providers during family conferences

Speaking a different language: Communication patterns of palliative care and pediatric intensive care unit providers during family conferences

Ciriello A G; October TW

Pediatric Critical Care Medicine

2017

quality of life; palliative therapy; retrospective study; thematic analysis; language; human experiment; health care personnel; genetic transcription; pediatric intensive care unit; speech; conference abstract; human; controlled study; medical information; uncertainty; audio recording; hopelessness

Introduction: Family conferences between parents of critically ill children and health care providers in the pediatric intensive care unit (PICU) serve an important role in family centered care. Many family conferences include palliative care providers to help navigate the conversation. We do not know how communication differs between conferences with and without the palliative care team. The objective of this study was to compare the language used by the palliative care (PC) team and the critical care team during decisionmaking family conferences. Methods: We conducted a qualitative retrospective review of 18 family conferences that were audio-recorded and transcribed. Nine conferences included both the PC team and PICU physicians, while 9 included only PICU physicians. Statements made by the PC team were collected and compared to statements made by the PICU team. Thematic analysis was performed to categorize the statements. Results: In 9 audio-recordings of PICU only conferences, we identified 526 PICU statements generating 15 thematic categories. The most common theme was medical information giving with 215/526 (41%) statements followed by discussing medical options (65/526, 12%). Other PICU themes included, "healthcare provider challenges (14/526, 3%)," hopelessness (30/526, 6%), and insensitivity (18/526, 3%). Among the 9 audio-recordings with the PC team present, there were 282 PC statements, which generated 11 thematic categories. The most common theme was support, compromising 78/282 (28%) statements. Other common PC themes included quality of life (35/282, 12%) and medical information giving (47/282, 17%). Overlapping themes used by both PICU and PC teams were encouraging consulting services, giving medical information, presenting medical options, normalizing emotions, praising the family, providing support, and discussing uncertainty. Both PICU and PC teams promoted family engagement by soliciting parent questions; however the PC team was more likely to use open-ended questions. Conclusions: Palliative care team language appears different from that of PICU physicians in that PICU physicians spend more time giving medical information while the palliative care team more commonly offers supportive statements and encourages parental involvement. Each provider serves a different role during family conferences. The addition of the palliative care team to PICU family conferences may offer a balanced approach to communication where the medical team provides important medical information while simultaneously offering support for the family.

December 2018 List