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.