On May 12, 2020, Cassandra Callender died at age 22. Pushed off the front pages by the latest new... more On May 12, 2020, Cassandra Callender died at age 22. Pushed off the front pages by the latest news about COVID-19, her untimely death invites reexamination of her story and the lessons it provides. "Cassandra C" (as she was referenced in news reports to protect her identity as a 17-year-old) was diagnosed with Hodgkin lymphoma in September 2014. 1 Though believed to have >80% chance of cure, she refused further treatment after receiving several cycles of chemotherapy in her home state of Connecticut. Her mother, who supported her decision, stated at the time, "She is very bright, very smart…My daughter does not want poison in her body…Does she know she will die? Yes. And do I know that? Yes." 1 The hospital contacted the Department of Children and Families, who took legal custody of Cassandra, precipitating a lengthy, contentious legal battle. The Connecticut Supreme Court ultimately ruled that Cassandra did not meet the standards set forth by the mature minor statute and thus could not legally refuse treatment. Since Cassandra was deemed not to be a "mature minor," she was held in the hospital for five months against her will and given intravenous chemotherapy over her objections. Regrettably, despite treatment, her cancer returned the following year. Then legally an adult, Cassandra initially took alternative treatments but ultimately decided to pursue chemotherapy, immunotherapy, and other standard treatments. Despite these efforts, she succumbed to her disease. Cassandra's story is troubling unto itself, but perhaps even more so when contrasted with the cases of Billy Best and Abraham Starchild Cherrix, two oft-cited teenagers similarly diagnosed with Hodgkin lymphoma who refused recommended therapies. Both young men refused further treatment after their initial cycle(s) of chemotherapy. No legal action was taken in the case of Billy, a resident of Massachusetts; Abraham's case went to court
Background In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be... more Background In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be made available in real-time, online, and free of charge to patients, a practice often referred to as "open notes. " This legislation was passed to support medical information transparency and reinforce trust in the clinician-patient relationship; however, it created additional complexities in that relationship and raises questions of what should be included in notes intended to be read by both clinicians and patients. Even prior to open notes, how an ethics consultant should document a clinical ethics consultation was widely debated as there can be competing interests, differing moral values, and disagreement about pertinent medical information in any given encounter. Patients can now access documentation of these discussions through online portals which broach sensitive topics related to end-of-life care, autonomy, religious/cultural conflict, veracity, confidentiality, and many others. Clinical ethics consultation notes must be ethically robust, accurate, and helpful for healthcare workers and ethics committee members, but now also sensitive to the needs of patients and family members who can read them in real-time. We explore implications of open notes for ethics consultation, review clinical ethics consultation documentation styles, and offer recommendations for documentation in this new era.
Billy Best was diagnosed with Hodgkin lymphoma in 1994 at age 16 and became well-known when he ra... more Billy Best was diagnosed with Hodgkin lymphoma in 1994 at age 16 and became well-known when he ran away from home to avoid receiving further chemotherapy. His story became national news when, with the support of his adopted parents, he returned home and opted to use complementary and alternative medicine (CAM) instead of standard chemotherapy and radiation for his cancer treatment. Now 25 years since Billy Best entered the public eye, his story is one that is frequently referenced in pediatrics, bioethics, and other related fields. Here, the authors examine the evolution of various features of this case, including treatment of Hodgkin lymphoma, the interplay between medicine and the media, the role of CAM in pediatric care, navigating entrenched disagreements and how best to integrate adolescents into health care decision-making, and the role of narrative in medical practice. The authors explore the unique role of each of these facets of Billy Best’s case, describing how each has or...
Multinational perspective on end of life issues in the ICU.- Critical illness and end of life iss... more Multinational perspective on end of life issues in the ICU.- Critical illness and end of life issues: a global view.- Death in a lonely place: pathophysiology of the dying patient.- History of the definitions of death: 18th to 20th century.- What it feels like to live and die on life support.- Who is in charge of the ICU?.- Communicating with the difficult family.- Emotions in the ICU.- Role of the ethics committee in end of life care.- Medical liability issues.- End of life issues vs. politics.- Comments from ancillary healthcare providers.- ICU of the future
Background: Deception can be defined as causing someone to accept a falsehood as true. Within sim... more Background: Deception can be defined as causing someone to accept a falsehood as true. Within simulation, a deception is an aspect of the environment for which there is no clear agreement or knowledge among facilitators and learners about its ground rules, boundaries, or existence. The psychological literature surrounding deception is mixed, and little simulation-specific research exists. Methods: This mixed-methods survey-based research explored attitudes for and against deception's use and facilitator perceptions of psychological risk and ethical harm. Subjects consisted of a random sample of members from three international simulation societies that included nurses, physicians, standardized patients, and educational specialists. The survey was designed and tested using an iterative process and distributed using SurveyMonkeyÔ. Descriptive statistics and thematic analyses were performed. Results: Eighty-four (11%) of surveys were completed. Thirty-three percent of respondents currently use modification/deception, whereas 61 to 75% of respondents expressed psychological and ethical concerns. Thematic analysis yielded five themes: types of modification/deception, decision-making considerations and guardrails, never events (high risk), potential detriments, and potential benefits. Conclusions: The use of deception appears relatively prevalent in the simulation community, but significant concerns also exist. Careful consideration of all relevant factors is needed if deception is to be used responsibly.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Jun 1, 2015
The use of deceptive methodology in simulation education is an emerging ethical controversy. At t... more The use of deceptive methodology in simulation education is an emerging ethical controversy. At the 2014 International Meeting on Simulation in Healthcare, arguments for and against its use were debated by simulation experts. What emerged from this discussion was an apparent disconnect between current practice and existing empiric research on this subject. At present, no framework exists to guide the simulation community's exploration of this issue of deception. After reviewing the relevant psychological literature, we propose a framework delineating discrete elements and important relationships, which enables a comprehensive view of the factors germane to simulations that use deception. We further comment on key pedagogical and psychological issues in the context of this framework and define an agenda for further research. Educators are encouraged to use this framework when determining whether, when, and how deception might be used and, if used, how it can be ethically justified and carefully implemented.
BACKGROUND Cultivating a healthy work environment and upholding patient safety are important prio... more BACKGROUND Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance. OBJECTIVE To assess the feasibility of monthly interdisciplinary educational rounds that support clinicians' ability to navigate workplace clinical and communication challenges while promoting interprofessional teamwork and self-care. METHODS The Program to Enhance Relational and Communication Skills rounds are an educational initiative within a large pediatric tertiary care hospital. Participation is voluntary and offered to interprofessional clinicians from 4 critical care units, cardiac catheterization unit, and intermediate care unit. Topics of monthly hour-long sessions are developed collaboratively. Feasibility is assessed by ongoing documentation of attendance. Postintervention questionnaires are used to evaluate the program's value. RESULTS Between April 2010 and December 2016, a total of 1156 clinicians participated (median, 18 per seminar): 653 nurses (56%), 103 social workers (9%), 102 child life specialists (9%), 32 psychologists (3%), 40 chaplains (3%), 18 physicians (2%), 18 ethicists (2%), and 190 others (16%), including medical interpreters, nursing students, and administrative staff. Ninety-two percent of participants rated their participation as "quite valuable" or "very valuable." Programs of highest interest included child assent, bereavement, social media, and workplace bullying. Evolution into actual clinical practice change remains a challenge for the future. CONCLUSION Our approach to communication and workplace challenges is relevant, user-friendly, and feasible. Diffi cult topics are addressed in real time, with clinicians learning interprofessionally. (Critical Care Nurse. 2018;38[6]:15-22) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Describe the key philosophy of the Program to Enhance Relational and Communication Skills (PERCS) rounds and Workshops 2. Identify the importance of PERCS champions to the promotion and development of PERCS rounds 3. Identify 3 important characteristics of the PERCS rounds that may aide in developing a similar educational initiative To complete evaluation for CE contact hour(s) for activity C1861, visit www.ccnonline.org and click the "CE Articles" button. No CE fee for AACN members. This activity expires on December 1, 2021. The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
Study question To determine the prevalence of occupational stress, fatigue, and burnout reported ... more Study question To determine the prevalence of occupational stress, fatigue, and burnout reported by UK embryologists and their perceived impact of work conditions on wellbeing. Summary answer The surveyed UK embryologists reported low somatic symptom severity and moderate perceived stress, but high levels of burnout and overall stressful working conditions. What is known already High levels of occupational stress, fatigue, burnout, and occupational health issues have been reported among embryologists in the Spanish, US, and international surveys. These issues were associated with embryologist’s occupational challenges and work conditions. Most (58.3%) of the previous UK survey participants reported work-related health issues, including stress/mental health problems (27.8%). However, that study did not evaluate stress and burnout utilizing the same standardized measures as recent US and international surveys, both of which identified considerably higher burnout than the Spanish surve...
A strong interpersonal relationship after stroke is important for the well-being of survivors and... more A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. The aim of this study is to enhance understanding about factors that contribute to relationship challenges among stroke dyads. Semi-structured interviews were conducted with N=19 spousal and non-spousal care dyads at approximately 3 month post-stroke. Qualitative data were analyzed using an interpretive description approach. Seven themes about factors that contribute to relationship challenges were identified, each with associated subthemes: (1) Coping with the direct effects of stroke; (2) Incongruence in perceptions between survivors and caregivers; (3) Lack of open communication; (4) Managing worries; (5) Adjusting to new roles; (6) Amplification of existing relationship issues, and; (7) Lack of support from other family members and friends. Findings highlight priority areas to consider in promoting strong relationships between survivors and family caregivers. Future research is needed to design interventions that family practitioners can use to disrupt negative communication cycles, promote empathy and collaboration between partners, and help dyads achieve a balance so that each person's needs are met.
To examine the most commonly reported emotions encountered among healthcare practitioners when ho... more To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed.
Objective: To analyze the communicative contributions of interdisciplinary professionals and fami... more Objective: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. Study Design: Physicians, nurses, social workers, and chaplains (n ¼ 50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). Result: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD ¼ P<0.005; RN ¼ P<0.05), focused more on family's opinion and understanding (MD ¼ P<0.01; RN ¼ P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. Conclusion: Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.
On May 12, 2020, Cassandra Callender died at age 22. Pushed off the front pages by the latest new... more On May 12, 2020, Cassandra Callender died at age 22. Pushed off the front pages by the latest news about COVID-19, her untimely death invites reexamination of her story and the lessons it provides. "Cassandra C" (as she was referenced in news reports to protect her identity as a 17-year-old) was diagnosed with Hodgkin lymphoma in September 2014. 1 Though believed to have >80% chance of cure, she refused further treatment after receiving several cycles of chemotherapy in her home state of Connecticut. Her mother, who supported her decision, stated at the time, "She is very bright, very smart…My daughter does not want poison in her body…Does she know she will die? Yes. And do I know that? Yes." 1 The hospital contacted the Department of Children and Families, who took legal custody of Cassandra, precipitating a lengthy, contentious legal battle. The Connecticut Supreme Court ultimately ruled that Cassandra did not meet the standards set forth by the mature minor statute and thus could not legally refuse treatment. Since Cassandra was deemed not to be a "mature minor," she was held in the hospital for five months against her will and given intravenous chemotherapy over her objections. Regrettably, despite treatment, her cancer returned the following year. Then legally an adult, Cassandra initially took alternative treatments but ultimately decided to pursue chemotherapy, immunotherapy, and other standard treatments. Despite these efforts, she succumbed to her disease. Cassandra's story is troubling unto itself, but perhaps even more so when contrasted with the cases of Billy Best and Abraham Starchild Cherrix, two oft-cited teenagers similarly diagnosed with Hodgkin lymphoma who refused recommended therapies. Both young men refused further treatment after their initial cycle(s) of chemotherapy. No legal action was taken in the case of Billy, a resident of Massachusetts; Abraham's case went to court
Background In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be... more Background In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be made available in real-time, online, and free of charge to patients, a practice often referred to as "open notes. " This legislation was passed to support medical information transparency and reinforce trust in the clinician-patient relationship; however, it created additional complexities in that relationship and raises questions of what should be included in notes intended to be read by both clinicians and patients. Even prior to open notes, how an ethics consultant should document a clinical ethics consultation was widely debated as there can be competing interests, differing moral values, and disagreement about pertinent medical information in any given encounter. Patients can now access documentation of these discussions through online portals which broach sensitive topics related to end-of-life care, autonomy, religious/cultural conflict, veracity, confidentiality, and many others. Clinical ethics consultation notes must be ethically robust, accurate, and helpful for healthcare workers and ethics committee members, but now also sensitive to the needs of patients and family members who can read them in real-time. We explore implications of open notes for ethics consultation, review clinical ethics consultation documentation styles, and offer recommendations for documentation in this new era.
Billy Best was diagnosed with Hodgkin lymphoma in 1994 at age 16 and became well-known when he ra... more Billy Best was diagnosed with Hodgkin lymphoma in 1994 at age 16 and became well-known when he ran away from home to avoid receiving further chemotherapy. His story became national news when, with the support of his adopted parents, he returned home and opted to use complementary and alternative medicine (CAM) instead of standard chemotherapy and radiation for his cancer treatment. Now 25 years since Billy Best entered the public eye, his story is one that is frequently referenced in pediatrics, bioethics, and other related fields. Here, the authors examine the evolution of various features of this case, including treatment of Hodgkin lymphoma, the interplay between medicine and the media, the role of CAM in pediatric care, navigating entrenched disagreements and how best to integrate adolescents into health care decision-making, and the role of narrative in medical practice. The authors explore the unique role of each of these facets of Billy Best’s case, describing how each has or...
Multinational perspective on end of life issues in the ICU.- Critical illness and end of life iss... more Multinational perspective on end of life issues in the ICU.- Critical illness and end of life issues: a global view.- Death in a lonely place: pathophysiology of the dying patient.- History of the definitions of death: 18th to 20th century.- What it feels like to live and die on life support.- Who is in charge of the ICU?.- Communicating with the difficult family.- Emotions in the ICU.- Role of the ethics committee in end of life care.- Medical liability issues.- End of life issues vs. politics.- Comments from ancillary healthcare providers.- ICU of the future
Background: Deception can be defined as causing someone to accept a falsehood as true. Within sim... more Background: Deception can be defined as causing someone to accept a falsehood as true. Within simulation, a deception is an aspect of the environment for which there is no clear agreement or knowledge among facilitators and learners about its ground rules, boundaries, or existence. The psychological literature surrounding deception is mixed, and little simulation-specific research exists. Methods: This mixed-methods survey-based research explored attitudes for and against deception's use and facilitator perceptions of psychological risk and ethical harm. Subjects consisted of a random sample of members from three international simulation societies that included nurses, physicians, standardized patients, and educational specialists. The survey was designed and tested using an iterative process and distributed using SurveyMonkeyÔ. Descriptive statistics and thematic analyses were performed. Results: Eighty-four (11%) of surveys were completed. Thirty-three percent of respondents currently use modification/deception, whereas 61 to 75% of respondents expressed psychological and ethical concerns. Thematic analysis yielded five themes: types of modification/deception, decision-making considerations and guardrails, never events (high risk), potential detriments, and potential benefits. Conclusions: The use of deception appears relatively prevalent in the simulation community, but significant concerns also exist. Careful consideration of all relevant factors is needed if deception is to be used responsibly.
Simulation in healthcare : journal of the Society for Simulation in Healthcare, Jun 1, 2015
The use of deceptive methodology in simulation education is an emerging ethical controversy. At t... more The use of deceptive methodology in simulation education is an emerging ethical controversy. At the 2014 International Meeting on Simulation in Healthcare, arguments for and against its use were debated by simulation experts. What emerged from this discussion was an apparent disconnect between current practice and existing empiric research on this subject. At present, no framework exists to guide the simulation community's exploration of this issue of deception. After reviewing the relevant psychological literature, we propose a framework delineating discrete elements and important relationships, which enables a comprehensive view of the factors germane to simulations that use deception. We further comment on key pedagogical and psychological issues in the context of this framework and define an agenda for further research. Educators are encouraged to use this framework when determining whether, when, and how deception might be used and, if used, how it can be ethically justified and carefully implemented.
BACKGROUND Cultivating a healthy work environment and upholding patient safety are important prio... more BACKGROUND Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance. OBJECTIVE To assess the feasibility of monthly interdisciplinary educational rounds that support clinicians' ability to navigate workplace clinical and communication challenges while promoting interprofessional teamwork and self-care. METHODS The Program to Enhance Relational and Communication Skills rounds are an educational initiative within a large pediatric tertiary care hospital. Participation is voluntary and offered to interprofessional clinicians from 4 critical care units, cardiac catheterization unit, and intermediate care unit. Topics of monthly hour-long sessions are developed collaboratively. Feasibility is assessed by ongoing documentation of attendance. Postintervention questionnaires are used to evaluate the program's value. RESULTS Between April 2010 and December 2016, a total of 1156 clinicians participated (median, 18 per seminar): 653 nurses (56%), 103 social workers (9%), 102 child life specialists (9%), 32 psychologists (3%), 40 chaplains (3%), 18 physicians (2%), 18 ethicists (2%), and 190 others (16%), including medical interpreters, nursing students, and administrative staff. Ninety-two percent of participants rated their participation as "quite valuable" or "very valuable." Programs of highest interest included child assent, bereavement, social media, and workplace bullying. Evolution into actual clinical practice change remains a challenge for the future. CONCLUSION Our approach to communication and workplace challenges is relevant, user-friendly, and feasible. Diffi cult topics are addressed in real time, with clinicians learning interprofessionally. (Critical Care Nurse. 2018;38[6]:15-22) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Describe the key philosophy of the Program to Enhance Relational and Communication Skills (PERCS) rounds and Workshops 2. Identify the importance of PERCS champions to the promotion and development of PERCS rounds 3. Identify 3 important characteristics of the PERCS rounds that may aide in developing a similar educational initiative To complete evaluation for CE contact hour(s) for activity C1861, visit www.ccnonline.org and click the "CE Articles" button. No CE fee for AACN members. This activity expires on December 1, 2021. The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
Study question To determine the prevalence of occupational stress, fatigue, and burnout reported ... more Study question To determine the prevalence of occupational stress, fatigue, and burnout reported by UK embryologists and their perceived impact of work conditions on wellbeing. Summary answer The surveyed UK embryologists reported low somatic symptom severity and moderate perceived stress, but high levels of burnout and overall stressful working conditions. What is known already High levels of occupational stress, fatigue, burnout, and occupational health issues have been reported among embryologists in the Spanish, US, and international surveys. These issues were associated with embryologist’s occupational challenges and work conditions. Most (58.3%) of the previous UK survey participants reported work-related health issues, including stress/mental health problems (27.8%). However, that study did not evaluate stress and burnout utilizing the same standardized measures as recent US and international surveys, both of which identified considerably higher burnout than the Spanish surve...
A strong interpersonal relationship after stroke is important for the well-being of survivors and... more A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. The aim of this study is to enhance understanding about factors that contribute to relationship challenges among stroke dyads. Semi-structured interviews were conducted with N=19 spousal and non-spousal care dyads at approximately 3 month post-stroke. Qualitative data were analyzed using an interpretive description approach. Seven themes about factors that contribute to relationship challenges were identified, each with associated subthemes: (1) Coping with the direct effects of stroke; (2) Incongruence in perceptions between survivors and caregivers; (3) Lack of open communication; (4) Managing worries; (5) Adjusting to new roles; (6) Amplification of existing relationship issues, and; (7) Lack of support from other family members and friends. Findings highlight priority areas to consider in promoting strong relationships between survivors and family caregivers. Future research is needed to design interventions that family practitioners can use to disrupt negative communication cycles, promote empathy and collaboration between partners, and help dyads achieve a balance so that each person's needs are met.
To examine the most commonly reported emotions encountered among healthcare practitioners when ho... more To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. Further education designed to increase clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed.
Objective: To analyze the communicative contributions of interdisciplinary professionals and fami... more Objective: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. Study Design: Physicians, nurses, social workers, and chaplains (n ¼ 50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). Result: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD ¼ P<0.005; RN ¼ P<0.05), focused more on family's opinion and understanding (MD ¼ P<0.01; RN ¼ P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. Conclusion: Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.
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