Participant Recruitment and Data Collection
The study protocol was approved by the local Institutional Review Board.
Data was collected in a Neurocritical care unit at a tertiary-level
academic medical center. A neutral observer observed discussions between
providers and patients’ families. The observer then discussed the study
with families or surrogate decision-makers and obtained informed
consent. Each member of the discussion – provider, family, nurse, and
observer – completed a questionnaire to evaluate the quality of
communication (Table 1).
We screened clinical encounters between July - August 2015 and June -
July 2016 where providers interacted with families to deliver medical
information, reviewed plan of care, or addressed goals of care. There
were no junior new trainees rotating in the ICU or participating in
family discussions hence this time was selected. Only encounters
involving English-speaking families of patients age 18 or older were
included. We excluded encounters where providers or families expressed
discomfort, the observer was absent, or families were grieving. We also
excluded encounters if a provider refused to complete surveys, or a
patient was deceased.