Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, Amsterdam, North Holland, 1105 AZ, The Netherlands.
Amsterdam Public Health research institute (APH), Amsterdam UMC, Amsterdam, The Netherlands.
Intensive Care Med. 2022 Jul;48(7):910-922. doi: 10.1007/s00134-022-06771-5. Epub 2022 Jun 30.
Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors' conflict management strategies and the effect of these strategies.
Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients' best interest. Transcripts were coded and analyzed using a qualitative deductive approach.
Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families' strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families' cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation.
This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.
重症监护是一个充满压力的环境，团队-家庭冲突很常见。如果管理不善，冲突可能会对所有相关方产生负面影响。先前的研究主要以回顾性的方式调查这些冲突及其管理。本研究旨在前瞻性地探讨团队-家庭冲突，包括其主要主题、复杂因素、医生的冲突管理策略以及这些策略的效果。
从开始怀疑治疗是否仍符合患者最佳利益时起，对一家大型大学附属医院的新生儿、儿科和成人重症监护病房的医生与重病患者家属之间的对话进行录音。使用定性演绎方法对转录本进行编码和分析。
在涉及 36 名患者中的 20 名患者的 101 次对话中，有 29 次（29%）发生了团队-家庭冲突。冲突大多涉及多个主题。我们确定了四个复杂的背景和/或家庭相关因素：诊断和预后的不确定性、家庭强烈的负面情绪、有限的健康素养以及责任负担。医生使用了四种总体策略来管理冲突，即内容导向、过程导向、道德和同理心策略。医生大多使用内容导向的策略，而不考虑重症监护环境。他们在大多数对话中都能够有效地解决冲突。然而，如果他们没有意识到家庭的暗示存在一个或多个复杂因素的线索，冲突很可能会在对话中持续存在。
本研究强调了医生根据具体冲突主题以及使特定冲突变得复杂的背景和家庭相关因素来调整沟通策略的重要性。
