Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
Division of Critical Care Medicine, Children's National Health Systems, Washington, DC.
JAMA Netw Open. 2018 Jul 6;1(3):e180351. doi: 10.1001/jamanetworkopen.2018.0351.
Pediatric intensive care unit care conferences often involve high-stakes decisions regarding critically ill children, resulting in strong family emotions. Families often report the need for physician empathy.
To evaluate the characteristics of physician empathetic statements during pediatric intensive care unit care conferences.
DESIGN, SETTING, AND PARTICIPANTS: In this single-center, cross-sectional, qualitative phenomenology study, 68 transcripts of audio-recorded care conferences were analyzed from an urban, quaternary medical center from January 3, 2013, to January 5, 2017. Thirty physicians and 179 family members of 68 children participated in care conferences. Data analysis was conducted from June 5, 2017, to October 12, 2017.
A qualitative thematic analysis was conducted to code physician empathetic statements and family's responses to these statements. Empathetic statements were classified using the previously published NURSE pneumonic (naming, understanding, respecting, supporting, exploring) and coded as unburied (statement followed by a pause allowing the family time to respond) or buried (empathetic statement encased in medical talk or terminated with a closed-ended statement). Family responses were categorized into 3 themes: alliance (emotion continued), cognitive (medical talk), or none. Missed opportunities for physicians to respond with empathy were identified.
Thirty physicians participated, of whom 13 (43%) were male, 24 (80%) were white, 24 (80%) had more than 5 years of practice, 10 (33%) specialized in critical care, and 7 (23%) specialized in hematology/oncology. Within 68 care conferences, physicians recognized families' emotional cues 74% of the time, making 364 empathetic statements. Of these statements, 224 (61.5%) were unburied and 140 (38.5%) were buried. Buried statements were most commonly followed by medical talk (133 [95.0%]). Unburied empathetic statements were associated with alliance responses from the family 71.4% of the time compared with 12.1% of the time when the statement was buried (odds ratio, 18; 95% CI, 10.1-32.4; P < .001). Physicians missed an opportunity to address emotion 26% of the time, with at least 1 missed opportunity occurring in 53 conferences (78%). Physicians attended to all family emotions in only 5 conferences (7%).
In this analysis, physicians responded with empathy frequently, but responses were buried within other pieces of medical data or missed entirely in nearly one-third of conferences. When physicians responded using unburied empathetic statements and allowed time for family members to respond, they were more likely to learn important information about the family's fears, values, and motivations.
儿科重症监护病房的护理会议经常涉及到危重病儿的高风险决策，导致强烈的家庭情绪。家庭经常报告需要医生的同理心。
评估儿科重症监护病房护理会议期间医生表达同理心的特征。
设计、地点和参与者：在这项单中心、横断面、定性现象学研究中，分析了 2013 年 1 月 3 日至 2017 年 1 月 5 日期间来自城市四级医疗中心的 68 份音频记录的护理会议的 68 份转录本。30 名医生和 68 名儿童的 179 名家属参加了护理会议。数据分析于 2017 年 6 月 5 日至 2017 年 10 月 12 日进行。
进行了定性主题分析，对医生表达同理心的语句和家属对这些语句的反应进行了编码。同理心语句使用之前发表的 NURSE 助记符（命名、理解、尊重、支持、探索）进行分类，并编码为未掩埋（语句后停顿，让家属有时间做出反应）或掩埋（同理心语句包含在医学讨论中或以封闭式语句结束）。确定了医生错过回应同理心的机会。
30 名医生参与其中，其中 13 名（43%）为男性，24 名（80%）为白人，24 名（80%）有超过 5 年的从业经验，10 名（33%）专业从事重症监护，7 名（23%）专业从事血液/肿瘤学。在 68 次护理会议中，医生识别家庭情绪线索的时间占 74%，共发表 364 条同理心语句。这些语句中，224 句（61.5%）未被掩埋，140 句（38.5%）被掩埋。被掩埋的语句最常见的是紧随其后的是医学讨论（133 次[95.0%]）。未掩埋的同理心语句与家庭的联盟反应相关的时间为 71.4%，而语句被掩埋的时间为 12.1%（优势比，18；95%CI，10.1-32.4；P < .001）。医生有 26%的时间错过了回应情绪的机会，其中至少有 1 次错过机会发生在 53 次会议（78%）中。只有 5 次会议（7%）的医生能够关注到所有家庭的情绪。
在这项分析中，医生经常表示同理心，但回应被埋在其他医学数据中，或者近三分之一的会议中完全错过了。当医生使用未掩埋的同理心语句并留出时间让家属做出反应时，他们更有可能了解到家庭恐惧、价值观和动机的重要信息。
