Original Article

Journal of Perinatology (2009) 29, 310–316; doi:10.1038/jp.2008.228; published online 15 January 2009

Analysis of enacted difficult conversations in neonatal intensive care

G Lamiani1,2, E C Meyer1,3, D M Browning1,4, D Brodsky1,5 and I D Todres1,6

  1. 1Institute for Professionalism and Ethical Practice, Children's Hospital, Boston, MA, USA
  2. 2Department of Medicine, Surgery and Dentistry, University of Milan, Italy
  3. 3Department of Psychiatry, Harvard Medical School, Boston, MA, USA
  4. 4Education Development Center Inc., Newton, MA, USA
  5. 5Neonatal Intensive Care Unit, Beth Israel Deaconess Center, Boston, MA, USA
  6. 6Medical Ethics Unit, Massachusetts General Hospital for Children, Boston, MA, USA

Correspondence: G Lamiani, CURA Research Center, University of Milan, Via Di Rudiní 8, 20142 Milan, Italy. E-mail: Giulia.lamiani@unimi.it

Received 18 June 2008; Revised 2 November 2008; Accepted 3 December 2008; Published online 15 January 2009.





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=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).



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=P<0.005; RN=P<0.05), focused more on family's opinion and understanding (MD=P<0.01; RN=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.



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.


difficult conversations, neonatal intensive care, interdisciplinary communication, RIAS, family-centered care