Stewart Russell, Hobbs Kyle, Dixon Kristopher, Navarrete Roberto Alejandro, Khan Jannat, Petrulis Mary E, Canzona Mollie, Sarwal Aarti
Department of Orthopedic Surgery University of South Carolina School of Medicine Greenville South Carolina USA.
Department of Neurocritical Care Intermountain Medical Center Salt Lake City Utah USA.
Health Sci Rep. 2021 Oct 22;4(4):e411. doi: 10.1002/hsr2.411. eCollection 2021 Dec.
Given the challenges of patient-provider communication in neurocritical care lacking robust decision-making tools on prognostication, we investigated concordance in perceptions of communication among participants in family discussions and assess the different domains of communication that affect these perceptions.
Prospective observational study conducted over 4 months in a tertiary-level academic medical center neurocritical care unit. Our study involved family discussions regarding plan of care for admitted patients observed by a neutral observer. All participants completed a survey. The first four questions rated the understanding of the discussion and general satisfaction; the remaining questions were open-ended to assess the quality of communication by the physician leading the discussion. Responses were scored and compared among participants using a Likert scale. A difference of < 1 in scores among participants was rated as concordance, whereas that of > 1 was designated as discordance. All open-ended responses were classified into six domains.
We observed 35 family discussions. Questions 1 to 3 inquiring on general satisfaction, impact, and understanding of treatment options yielded 99 cross-comparisons per question (297 compared responses). Most responses were either "Strongly Agree" or "Agree," with "Neutral" or "Disagree" responses being more prevalent in Question 2 regarding the impact of the conversation. Overall concordance of responses between participants was 88% with a lower rate of concordance (72%) on Q2. Further open-ended questions queried observers on specific physician-spoken content, and answers were analyzed to identify domains that affected the perception of quality of communication. Education was the most frequently cited domain of communication in response to open-ended questions. Among family and neutral observers, empathy was frequently listed, whereas providers more often listed family engagement.
Overall, satisfaction was high among providers, families, and the observer regarding the quality of communication during family discussions in the unit. Perceptual differences emerged over whether this communication impacted healthcare decision-making during that encounter.
鉴于神经重症监护中患者与医护人员沟通面临挑战且缺乏有力的预后决策工具，我们调查了家庭讨论参与者之间沟通认知的一致性，并评估影响这些认知的不同沟通领域。
在一家三级学术医疗中心的神经重症监护病房进行了为期4个月的前瞻性观察研究。我们的研究涉及由一名中立观察者观察的关于住院患者护理计划的家庭讨论。所有参与者都完成了一项调查。前四个问题对讨论的理解和总体满意度进行评分；其余问题为开放式问题，以评估主持讨论的医生的沟通质量。使用李克特量表对参与者的回答进行评分和比较。参与者得分差异<1被评为一致，而>1则被指定为不一致。所有开放式回答被分为六个领域。
我们观察了35次家庭讨论。询问总体满意度、影响和对治疗方案理解的问题1至3，每个问题产生了99次交叉比较（共297次比较回答）。大多数回答为“强烈同意”或“同意”，在关于谈话影响的问题2中，“中立”或“不同意”的回答更为普遍。参与者之间回答的总体一致性为88%，问题2的一致性率较低（72%）。进一步的开放式问题询问观察者关于医生具体所说内容，对答案进行分析以确定影响沟通质量认知的领域。在回答开放式问题时，教育是最常被提及的沟通领域。在家庭成员和中立观察者中，同理心经常被列出，而医护人员更常列出家庭参与。
总体而言，医护人员、家庭成员和观察者对该病房家庭讨论期间的沟通质量满意度较高。对于这种沟通在那次会诊期间是否影响医疗决策出现了认知差异。
