Is it my turn to speak? An analysis of the dialogue in the family-physician intensive care unit conference.

OBJECTIVE

Apply turn analysis to family conferences in the pediatric intensive care unit.

METHODS

We analyzed 39 audio-recorded family conferences using the Roter Interaction Analysis System. A turn was defined as a continuous block of uninterrupted statements by a speaker.

RESULTS

Opening turns by the healthcare team (HCT) averaged 207s, compared to 28s for families. Turn density (number of statements/turn) was 6 for the HCT versus 2 for families (p<0.0001). An average of 21 turns (26%) occurred between HCT members, resulting in substantial sections of dialogue excluding the family. Average HCT dialogue reflected a literacy demand of a 9th grade level, whereas family dialogue averaged a 5th grade level (p<0.0001). More HCT turns were related to higher reading level demand (r=0.34; p=0.03) and lower levels of patient-centeredness (r=-0.35, p=0.03).

CONCLUSION

The healthcare team can improve the communication experience for families by encouraging and facilitating family engagement in conference dialogue.

PRACTICE IMPLICATIONS

Changing how the healthcare team engages with families during communication events is vital to improving the experience for families. Our data suggests simple adjustments, such as limiting medical jargon and inter-team turns may lead to increased family participation and more family-centered care.