O3208: "Such a Lovely Family": How We Talk About and to Patient Families

Background: Research has begun to explore the impact of bias and language in written medical records. Little is known about conversational language about families amongst team members. Our study seeks to characterize how teams talk about families (TTAF) in interprofessional team meetings and the impact this has on team communication with families.

Methods: Interprofessional team meetings and team-family meetings for patients in the pediatric Cardiac Intensive Care Unit were audio recorded and transcribed. Constant comparative qualitative methods identified TTAF themes. Family meetings were coded for team expressions of empathy, assessing parental understanding, eliciting concerns and asking how much information families want to know using a validated codebook. Parental surveys collected demographic data. Pearson Correlation test assessed relationships and Wilcoxon Rank Sum test assessed differences between TTAF theme and team communication behaviors, family meeting duration, and parent/child race.

Results: In 28 family meetings, 21 parents/children (75%) identified as white. Physicians, advanced practice providers, nursing, social workers, and other ancillary staff attended team meetings. Twenty-six family meetings (92%) included at least one parent, physician, social worker and nurse.

Three themes (Table 1) of how TTAF were identified: 57% Positive (16 families), 36% Concerned (10 families), 7% Negative (2 families). Examples of each theme are in Table 2.

No significant correlation existed between TTAF theme and race. Total empathic statements differed significantly by race and TTAF theme, with more empathic statements made by the team in meetings with negative/concerned (p < 0.01) and white families (p < 0.01). Although non-significant, there was a trend toward teams responding with empathy less often for positive families than negative/concerned (r -0.36, p 0.06). There was no relationship between TTAF theme or race and eliciting concerns. Assessing understanding did not significantly differ by TTAF theme or race. Only one family was asked how much they want to know. White families (p < 0.01) and negative/concerned families (p < 0.01) had significantly longer family meetings.

Conclusion: This study describes three major themes for how TTAF in interdisciplinary team meetings. We explored relationships and differences between team communication behaviors with families in family meetings and meeting duration by TTAF theme and race, finding significant differences in several areas. In general, teams did not perform recommended high quality family centered communication behaviors like assessing understanding, eliciting concerns or asking how much families want to know and did not do so more in meetings with negative/concerned TTAF families, as might be expected. Further research should examine how TTAF may impact communication behaviors with families and the potential impact of racial biases, as well as the relationship between how TTAF and family satisfaction with communication.