Perceptions of Quality of Communication in Family Interactions in Neurocritical Care

Objective: To investigate concordance in perceptions of communication among participants in family discussions and assess the importance of different domains of communication in a neurocritical care unit. Methods: Prospective observational study conducted in a neurocritical care unit. Our study involved family discussions regarding plan of care for patients admitted to the unit. All participants completed a survey. The first 4 questions rated understanding of the discussion and general satisfaction; the remaining questions were open-ended to assess quality of communication by the physician leading the discussion. Responses were scored and compared among participants using a Likert scale. A difference of 2 was designated as discordance. All open-ended responses were classified into six domains. Results: We observed 35 family discussions. Questions 1-3 yielded 99 cross-comparisons per question (total of 297 compared responses). Most responses were either “Strongly Agree” or “Agree”; with “Neutral” or “Disagree” responses being more prevalent in Question 2. Overall concordance of responses between participants was 88%. Education was the most frequently cited domain of communication in response to open-ended questions. Among family and neutral observers, empathy was frequently listed, while providers more often listed family engagement. Conclusion: Overall, satisfaction was high among providers, families, and the observer regarding quality of communication during family discussions in the unit. Perceptual differences emerged over whether this communication impacted healthcare decision-making during that encounter.