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Quality of Communication in Interpreted Versus Noninterpreted PICU Family Meetings*

Van Cleave, Alisa C. MD1; Roosen-Runge, Megan U. MPH2; Miller, Alison B. MD3; Milner, Lauren C. PhD4; Karkazis, Katrina A. PhD, MPH4; Magnus, David C. PhD4

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000177
Pediatric Critical Care
Abstract

Objectives: To describe the quality of physician-family communication during interpreted and noninterpreted family meetings in the PICU.

Design: Prospective, exploratory, descriptive observational study of noninterpreted English family meetings and interpreted Spanish family meetings in the pediatric intensive care setting.

Setting: A single, university-based, tertiary children’s hospital.

Subjects: Participants in PICU family meetings, including medical staff, family members, ancillary staff, and interpreters.

Interventions: Thirty family meetings (21 English and nine Spanish) were audio-recorded, transcribed, de-identified, and analyzed using the qualitative method of directed content analysis.

Measurements and Main Results: Quality of communication was analyzed in three ways: 1) presence of elements of shared decision-making, 2) balance between physician and family speech, and 3) complexity of physician speech. Of the 11 elements of shared decision-making, only four occurred in more than half of English meetings, and only three occurred in more than half of Spanish meetings. Physicians spoke for a mean of 20.7 minutes, while families spoke for 9.3 minutes during English meetings. During Spanish meetings, physicians spoke for a mean of 14.9 minutes versus just 3.7 minutes of family speech. Physician speech complexity received a mean grade level score of 8.2 in English meetings compared to 7.2 in Spanish meetings.

Conclusions: The quality of physician-family communication during PICU family meetings is poor overall. Interpreted meetings had poorer communication quality as evidenced by fewer elements of shared decision-making and greater imbalance between physician and family speech. However, physician speech may be less complex during interpreted meetings. Our data suggest that physicians can improve communication in both interpreted and noninterpreted family meetings by increasing the use of elements of shared decision-making, improving the balance between physician and family speech, and decreasing the complexity of physician speech.

Author Information

1Palliative Medicine Fellowship Program, Division of Gerontology, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA.

2Stanford University School of Medicine, Stanford, CA.

3Primary Children’s Medical Center, Division of Pediatric Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT.

4Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA.

* See also p. 1569.

This work was performed at Lucile Packard Children’s Hospital, Stanford University School of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Stanford Center for Biomedical Ethics at Stanford University.

Drs. Van Cleave, Roosen-Runge, Miller, Karkazis, and Magnus received support for article research (ancillary support) from Stanford Center for Clinical and Translational Education and Research (which is supported by the National Institutes of Health [NIH] via Clinical and Translational Science Award (CTSA) grant UL1 TR000093). Dr. Milner received support for article research (ancillary support) from Stanford Center for Clinical and Translational Education and Research (which is supported by the NIH via CTSA grant UL1 TR000093). Her institution received grant support.

Address requests for reprints to: Alisa C. Van Cleave, MD, Palliative Medicine Fellowship Program, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499. E-mail: alisavc@uw.edu

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins