Early neonatal intensive care unit family meetings: Communication patterns, patient-centeredness, and family perception.

Abstract

Early family meetings in the neonatal intensive care unit (NICU) represent a crucial communication opportunity between families and clinicians. We examined clinician-family patterns of communication, patient-centeredness, and family perception during early family meetings. We audio-recorded "first family meetings" (meetings in the first 10 days of admission to review anticipated NICU course) for infants born < 35 weeks' gestational age in a level III NICU. We evaluated clinician and family contribution to meetings and coded clinician-family communication using the Roter Interaction Analysis System (RIAS). Additionally, the RIAS was used to quantify "patient-centeredness" using a ratio comparing psychosocial and socioemotional content to biomedical content. After each meeting, we administered a survey including demographics and the validated 14-item Communication Assessment Tool to assess family perception on a 5-point Likert scale. We used descriptive statistics to analyze communication and experience. We analyzed 19 meetings, including 16 in English and 3 interpreted (2 Portuguese, 1 Spanish). During meetings, clinicians spoke more (clinicians: 71.9%, parents: 25.0%) and asked more questions (clinician: 61.9%, parents: 36.0%) compared to families. The most frequent content was medical information from clinicians (20.1% of meeting time). The median patient-centeredness score was 0.95, suggesting a balance between psychosocial and medical content. The lowest rated Communication Assessment Tool items were 'encouraged me to ask questions' and 'discussed next steps;' for these items, 87.5% of families reported excellent. In early NICU family meetings, the amount of conversation was dominated by clinicians compared to parents, although medical and socioemotional discussion were relatively balanced. Families were satisfied with these meetings, but more work is needed to facilitate bidirectional communication. A routine, early NICU family meeting may allow time to discuss family context and emotional support in addition to medical information. Families can be encouraged to speak and ask more questions during meetings.