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Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study

IMPORTANCE: Pediatric intensive care unit care conferences often involve high-stakes decisions regarding critically ill children, resulting in strong family emotions. Families often report the need for physician empathy. OBJECTIVE: To evaluate the characteristics of physician empathetic statements d...

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Autores principales: October, Tessie W., Dizon, Zoelle B., Arnold, Robert M., Rosenberg, Abby R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324292/
https://www.ncbi.nlm.nih.gov/pubmed/30646015
http://dx.doi.org/10.1001/jamanetworkopen.2018.0351
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author October, Tessie W.
Dizon, Zoelle B.
Arnold, Robert M.
Rosenberg, Abby R.
author_facet October, Tessie W.
Dizon, Zoelle B.
Arnold, Robert M.
Rosenberg, Abby R.
author_sort October, Tessie W.
collection PubMed
description IMPORTANCE: Pediatric intensive care unit care conferences often involve high-stakes decisions regarding critically ill children, resulting in strong family emotions. Families often report the need for physician empathy. OBJECTIVE: To evaluate the characteristics of physician empathetic statements during pediatric intensive care unit care conferences. DESIGN, SETTING, AND PARTICIPANTS: In this single-center, cross-sectional, qualitative phenomenology study, 68 transcripts of audio-recorded care conferences were analyzed from an urban, quaternary medical center from January 3, 2013, to January 5, 2017. Thirty physicians and 179 family members of 68 children participated in care conferences. Data analysis was conducted from June 5, 2017, to October 12, 2017. MAIN OUTCOMES AND MEASURES: A qualitative thematic analysis was conducted to code physician empathetic statements and family’s responses to these statements. Empathetic statements were classified using the previously published NURSE pneumonic (naming, understanding, respecting, supporting, exploring) and coded as unburied (statement followed by a pause allowing the family time to respond) or buried (empathetic statement encased in medical talk or terminated with a closed-ended statement). Family responses were categorized into 3 themes: alliance (emotion continued), cognitive (medical talk), or none. Missed opportunities for physicians to respond with empathy were identified. RESULTS: Thirty physicians participated, of whom 13 (43%) were male, 24 (80%) were white, 24 (80%) had more than 5 years of practice, 10 (33%) specialized in critical care, and 7 (23%) specialized in hematology/oncology. Within 68 care conferences, physicians recognized families’ emotional cues 74% of the time, making 364 empathetic statements. Of these statements, 224 (61.5%) were unburied and 140 (38.5%) were buried. Buried statements were most commonly followed by medical talk (133 [95.0%]). Unburied empathetic statements were associated with alliance responses from the family 71.4% of the time compared with 12.1% of the time when the statement was buried (odds ratio, 18; 95% CI, 10.1-32.4; P < .001). Physicians missed an opportunity to address emotion 26% of the time, with at least 1 missed opportunity occurring in 53 conferences (78%). Physicians attended to all family emotions in only 5 conferences (7%). CONCLUSIONS AND RELEVANCE: In this analysis, physicians responded with empathy frequently, but responses were buried within other pieces of medical data or missed entirely in nearly one-third of conferences. When physicians responded using unburied empathetic statements and allowed time for family members to respond, they were more likely to learn important information about the family’s fears, values, and motivations.
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spelling pubmed-63242922019-01-17 Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study October, Tessie W. Dizon, Zoelle B. Arnold, Robert M. Rosenberg, Abby R. JAMA Netw Open Original Investigation IMPORTANCE: Pediatric intensive care unit care conferences often involve high-stakes decisions regarding critically ill children, resulting in strong family emotions. Families often report the need for physician empathy. OBJECTIVE: To evaluate the characteristics of physician empathetic statements during pediatric intensive care unit care conferences. DESIGN, SETTING, AND PARTICIPANTS: In this single-center, cross-sectional, qualitative phenomenology study, 68 transcripts of audio-recorded care conferences were analyzed from an urban, quaternary medical center from January 3, 2013, to January 5, 2017. Thirty physicians and 179 family members of 68 children participated in care conferences. Data analysis was conducted from June 5, 2017, to October 12, 2017. MAIN OUTCOMES AND MEASURES: A qualitative thematic analysis was conducted to code physician empathetic statements and family’s responses to these statements. Empathetic statements were classified using the previously published NURSE pneumonic (naming, understanding, respecting, supporting, exploring) and coded as unburied (statement followed by a pause allowing the family time to respond) or buried (empathetic statement encased in medical talk or terminated with a closed-ended statement). Family responses were categorized into 3 themes: alliance (emotion continued), cognitive (medical talk), or none. Missed opportunities for physicians to respond with empathy were identified. RESULTS: Thirty physicians participated, of whom 13 (43%) were male, 24 (80%) were white, 24 (80%) had more than 5 years of practice, 10 (33%) specialized in critical care, and 7 (23%) specialized in hematology/oncology. Within 68 care conferences, physicians recognized families’ emotional cues 74% of the time, making 364 empathetic statements. Of these statements, 224 (61.5%) were unburied and 140 (38.5%) were buried. Buried statements were most commonly followed by medical talk (133 [95.0%]). Unburied empathetic statements were associated with alliance responses from the family 71.4% of the time compared with 12.1% of the time when the statement was buried (odds ratio, 18; 95% CI, 10.1-32.4; P < .001). Physicians missed an opportunity to address emotion 26% of the time, with at least 1 missed opportunity occurring in 53 conferences (78%). Physicians attended to all family emotions in only 5 conferences (7%). CONCLUSIONS AND RELEVANCE: In this analysis, physicians responded with empathy frequently, but responses were buried within other pieces of medical data or missed entirely in nearly one-third of conferences. When physicians responded using unburied empathetic statements and allowed time for family members to respond, they were more likely to learn important information about the family’s fears, values, and motivations. American Medical Association 2018-07-06 /pmc/articles/PMC6324292/ /pubmed/30646015 http://dx.doi.org/10.1001/jamanetworkopen.2018.0351 Text en Copyright 2018 October TW et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
October, Tessie W.
Dizon, Zoelle B.
Arnold, Robert M.
Rosenberg, Abby R.
Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title_full Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title_fullStr Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title_full_unstemmed Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title_short Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study
title_sort characteristics of physician empathetic statements during pediatric intensive care conferences with family members: a qualitative study
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324292/
https://www.ncbi.nlm.nih.gov/pubmed/30646015
http://dx.doi.org/10.1001/jamanetworkopen.2018.0351
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