Gramszlo Colette, Cetin Arzu, Walter Jennifer K
Department of Child and Adolescent Psychiatry and Behavioral Sciences (C.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Clinical Psychiatry (C.G.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clinical Futures (A.C.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Pain Symptom Manage. 2025 Mar;69(3):261-268. doi: 10.1016/j.jpainsymman.2024.11.014. Epub 2024 Nov 24.
Uncertainty is a known barrier to effective communication during family meetings in the pediatric cardiac intensive care unit (CICU), however, limited data has characterized patterns of communication during these meetings, limiting our ability to make best practice recommendations to clinicians.
To characterize how uncertainty is communicated by cardiac critical care teams during family meetings, to characterize family responses to uncertainty, and to explore how expressions of uncertainty impact specific responses.
We conducted a retrospective study of 58 family meetings recorded in a pediatric CICU. Participants were families of patients admitted to the CICU and members of the interprofessional CICU team. We coded uncertainty statements expressed by clinicians and family responses to uncertainty statements. Codes were extracted and analyzed for thematic content.
We identified three themes around which clinicians expressed uncertainty: prognosis, treatment trajectories, and discharge planning. Expressions were most frequently unburied (62.3%) and implicit (66.5%). Five themes were identified within family responses to uncertainty: Brief acknowledgment (36.7%); clarification (30.0%); summary (12.3%); child information (12.3%); and emotions, preferences, and reflections (8.6%). Brief acknowledgements often followed lengthy, complex medical information provided by clinicians. Families often responded to implicitly communicated uncertainty by summarizing, clarifying, and providing additional details about their experiences, observations, and preferences.
Our results encourage clinicians to communicate uncertainty in an unburied and explicit manner, which may reduce the burden on families to engage in effective communication strategies, such as clarifying and summarizing opaquely stated information.
不确定性是儿科心脏重症监护病房（CICU）家庭会议期间有效沟通的一个已知障碍，然而，关于这些会议期间沟通模式的数据有限，这限制了我们向临床医生提出最佳实践建议的能力。
描述心脏重症监护团队在家庭会议期间如何传达不确定性，描述家庭对不确定性的反应，并探讨不确定性的表达如何影响具体反应。
我们对在儿科CICU记录的58次家庭会议进行了回顾性研究。参与者是入住CICU的患者家属和跨专业CICU团队的成员。我们对临床医生表达的不确定性陈述以及家庭对不确定性陈述的反应进行了编码。提取编码并分析其主题内容。
我们确定了临床医生表达不确定性的三个主题：预后、治疗轨迹和出院计划。表达最常是隐晦的（62.3%）和隐含的（66.5%）。在家庭对不确定性的反应中确定了五个主题：简短认可（36.7%）；澄清（30.0%）；总结（12.3%）；儿童信息（12.3%）；以及情绪、偏好和反思（8.6%）。简短认可通常在临床医生提供冗长、复杂的医疗信息之后。家庭通常通过总结、澄清并提供关于他们的经历、观察和偏好的更多细节来回应隐含传达的不确定性。
我们的结果鼓励临床医生以公开和明确的方式传达不确定性，这可能减轻家庭采用有效沟通策略的负担，例如澄清和总结隐晦表述的信息。
