Perceptions of quality of communication in family interactions in neurocritical care.

Autor: Stewart R; Department of Orthopedic Surgery University of South Carolina School of Medicine Greenville South Carolina USA., Hobbs K; Department of Neurocritical Care Intermountain Medical Center Salt Lake City Utah USA., Dixon K; Department of Pediatrics Wake Forest School of Medicine Winston-Salem North Carolina USA., Navarrete RA; Department of Urology University of Michigan Ann Arbor Michigan USA., Khan J; Department of Orthopedic Surgery Rush University Chicago Illinois USA., Petrulis ME; Department of Neurology Washington University St. Louis Missouri USA., Canzona M; Department of Communication Wake Forest University Winston-Salem North Carolina USA.; Department of Social Sciences & Health Policy Wake Forest School of Medicine Winston-Salem North Carolina USA., Sarwal A; Department of Neurocritical Care Wake Forest School of Medicine Winston-Salem North Carolina USA.
Jazyk: angličtina
Zdroj: Health science reports [Health Sci Rep] 2021 Oct 22; Vol. 4 (4), pp. e411. Date of Electronic Publication: 2021 Oct 22 (Print Publication: 2021).
DOI: 10.1002/hsr2.411
Abstrakt: 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.
Competing Interests: The authors declare no conflicts of interest.
(© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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