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  • Original Article
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Analysis of enacted difficult conversations in neonatal intensive care

Journal of Perinatology volume 29, pages 310–316 (2009)Cite this article

Abstract

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=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=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.

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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Acknowledgements

We honor and dedicate this work to I David Todres, our friend and colleague, who passed away during the final revisions of this article. We acknowledge the Argosy Foundation for financial support of this work. We thank Anne Hansen, MD, Susan Larson, MS, Debra Roter, MPH. DrDh, Robert Truog, MD, and Allyson Wall, BA, for their many contributions. The authors express their gratitude to Pam Varrin, PhD, Erin Ward, MEd, Meg Comeau, MHA, who enriched the PERCS workshops offering parent perspectives, and to the actors and PERCS participants.

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Authors and Affiliations

  1. Institute for Professionalism and Ethical Practice, Children's Hospital, Boston, MA, USA

    G Lamiani, E C Meyer, D M Browning, D Brodsky & I D Todres

  2. Department of Medicine, Surgery and Dentistry, University of Milan, Italy

    G Lamiani

  3. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    E C Meyer

  4. Education Development Center Inc., Newton, MA, USA

    D M Browning

  5. Neonatal Intensive Care Unit, Beth Israel Deaconess Center, Boston, MA, USA

    D Brodsky

  6. Medical Ethics Unit, Massachusetts General Hospital for Children, Boston, MA, USA

    I D Todres

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  1. G Lamiani
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  2. E C Meyer
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  4. D Brodsky
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  5. I D Todres
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Corresponding author

Correspondence to G Lamiani.

Additional information

Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp).

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Lamiani, G., Meyer, E., Browning, D. et al. Analysis of enacted difficult conversations in neonatal intensive care. J Perinatol 29, 310–316 (2009). https://doi.org/10.1038/jp.2008.228

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