643 - Neonatal Intensive Care Unit (NICU) Family Meetings: Communication Patterns, Patient-Centeredness, and Family Perception

Publication Number: 4629.643

Nikita S. Kalluri, UMass Medical School, Boston, MA, United States; Timmy Ho, Harvard Medical School, Boston, MA, United States; Sofia Gnecco, Beth Israel Deaconess Medical Center, Brookline, MA, United States; Maria Laura Mourão, Beth Israel Deaconess Medical Center, Boston, MA, United States; Alisa Khan, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Margaret Parker, UMass Chan School of Medicine, Worcester, MA, United States

Background: Infants cared for in the neonatal intensive care unit (NICU) are a vulnerable population for whom family-centered care is a priority. Early family meetings are critical communication touchpoints that can lay the groundwork for improved family-centered care. During meetings, clinicians can communicate medical plans and offer emotional support and resources. Parents can ask questions and build trust with clinicians. The content and quality of these routine meetings have not been quantitatively assessed.

Objective: To evaluate clinician-family communication patterns, family-centeredness, and family perception of communication during routine family meetings in the first week of admission for premature infants hospitalized in the NICU.

Design/Methods: We audio-recorded 'first family meetings' (early in admission to review anticipated NICU course) for infants born < 35 weeks gestational age in a level III NICU. We evaluated contribution to meetings by clinicians and families, coded clinician-family communication during meetings using the Roter Interaction Analysis System (RIAS), and combined RIAS codes into composites. To assess communication quality, the RIAS quantified "patient-centeredness" using a ratio comparing psychosocial and socioemotional content (e.g., to share family context, build rapport) vs biomedical content (e.g., medical management, prognosis). After each meeting, we administered a survey including demographics and the validated 14-item Communication Assessment Tool (CAT) to assess family perception on a 5-point Likert scale. We used descriptive statistics to analyze communication and experience.

Results: We recorded 19 meetings from 11/2023-10/2024, including 16 in English and 3 with an interpreter (2 Portuguese, 1 Spanish). Sixteen families completed the demographic and CAT survey. During meetings, clinicians spoke more and asked more questions than families. The median patient-centeredness score was 0.95, suggesting a balance between psychosocial and medical content (Table 1). Table 2 shows distribution and examples of RIAS composites. Of clinician speech, 43.8% was delivery of medical information. Parent speech was mostly facilitative (34.8%) and positive talk (28.5%). The lowest rated CAT items were 'encouraged me to ask questions' and 'discussed next steps,' where 87.5% of families reported excellent (Table 3).

Conclusion(s): During NICU family meetings, though medical and socioemotional discussion was well-balanced, clinicians spoke and asked more questions than families. Families generally rate these meetings highly but should be encouraged to speak and ask more questions during meetings.

Table 1
Family-reported sociodemographic characteristics (n = 16) and meeting characteristics (n = 19). Three English-speaking families were unable to complete the post-meeting questionnaire due to logistical constraints.

Table 2
Roter Interaction Analysis System (RIAS) composites with examples using quotes taken from first family meeting audio-recordings, and average percentage of time spoken in each composite during the meeting.

Table 3
Results of the family-reported Communication Assessment Tool after first family meeting (n=16). Consistent with the tool's reporting recommendations, we report the "top box" score, or the percentage of families who rated each item as "excellent" (highest rating). One questionnaire was filled out per family.