Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Pain Symptom Manage. 2019 Jun;57(6):1089-1098. doi: 10.1016/j.jpainsymman.2019.03.002. Epub 2019 Mar 12.
Parents of children in the pediatric cardiac intensive care unit (CICU) report inadequate communication and a lack of empathy during conversations with their clinicians.
To assess quantitatively and qualitatively the contributions made by team members of different professions in communicating with parents during family meetings.
Prospective 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.
Across 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.
Coordination of team members' roles in the meetings may improve parental engagement necessary for decision-making and empathic responses that are often missed.
儿科心脏重症监护病房（CICU）的患儿家长报告称，他们在与临床医生交谈时，沟通不充分且缺乏同理心。
定量和定性评估不同专业团队成员在医患会议中与家长沟通时的贡献。
前瞻性观察研究。该研究在费城儿童医院的儿科 CICU 进行。研究对象为在 CICU 住院时间超过两周的患者的跨专业团队成员。我们使用定量对话归因和编码来比较不同专业角色的与会者的发言时长和发言类型。使用 SCOPE 编码手册和其他家庭会议最佳实践中的定量编码来衡量沟通行为。对护士和社会工作者的贡献进行定性分析，以确定其他方法无法捕捉到的主题。
在 10 次会议中，医生平均发言时长为 78.1%（标准差为 10.7%），非医生为 9.6%（标准差为 7.8%），家长为 17.4%（标准差为 12.2%）。平均每次会议评估家长理解程度为 0.2 次（标准差为 0.4 次）。家长平均每次会议表达情绪 4.2 次（标准差为 7.1 次），临床团队每次会议回应同理心 2.2 次（标准差为 4.3 次）。所有临床医生的同理心回应都只占他们总贡献的一小部分。在医生表示其他团队成员可以发言之前，对话几乎完全是医生和家属之间进行的。
协调会议中团队成员的角色可能会改善决策所需的家长参与度，并增加经常被忽视的同理心回应。
