Perceptions of quality of communication in family interactions in neurocritical care

Health Science Reports

Mollie Canzona¹  Kyle Hobbs²  Aarti Sarwal³  Mary E. Petrulis⁴  Jannat Khan⁵  Russell Stewart⁶  Kristopher Dixon⁷  Roberto Alejandro Navarrete⁸ 

[1] Department of Communication Wake Forest University Winston‐Salem North Carolina USA;Department of Neurocritical Care Intermountain Medical Center Salt Lake City Utah USA;Department of Neurocritical Care Wake Forest School of Medicine Winston‐Salem North Carolina USA;Department of Neurology Washington University St. Louis Missouri USA;Department of Orthopedic Surgery Rush University Chicago Illinois USA;Department of Orthopedic Surgery University of South Carolina School of Medicine Greenville South Carolina USA;Department of Pediatrics Wake Forest School of Medicine Winston‐Salem North Carolina USA;Department of Urology University of Michigan Ann Arbor Michigan USA;

关键词: healthcare;    medical research;    patient‐centered care;   

DOI  :  10.1002/hsr2.411

来源: DOAJ

【 摘 要 】

Abstract Objective 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. Methods 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. Results 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. Conclusion 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.

【 授权许可】

Unknown