384 - Optimizing Delivery of Family-Centered Care in the NICU: Solution Focused Qualitative Interviews

Publication Number: 4376.384

Laura A. Rose, University of California, San Diego School of Medicine, La Jolla, CA, United States; Mia Malcolm, Ollie Hinkle Heart Foundation, St. Louis, MO, United States; Morgan E. Kowalski, Stanford Medical Center, Clemson, SC, United States; Henry Lee, University of California San Diego, La Jolla, CA, United States; Keira Sorrells, NICU Parent Network, Lanesville, IN, United States; Jasneet Bajwa, Touro University California School of Medicine, Vallejo, CA, United States; Jessica Liu, Stanford University School of Medicine, Palo Alto, CA, United States; Malathi Balasundaram, Stanford University School of Medicine, Mountain View, CA, United States

Background: Family-centered care (FCC) places the infant's family at the center of NICU care, emphasizing shared caregiving and decision-making. Implementation of FCC is often limited by restricted family presence, inconsistent support services, lack of awareness about FCC delivery, and communication barriers. Successful FCC requires mutual trust and collaboration between families and healthcare providers.

Objective: To explore the current state of FCC delivery and provide solution-focused interviews in NICUs internationally.

Design/Methods: This cross-sectional, descriptive mixed-methods study was conducted by the FCC Taskforce. Beginning October 2024, an FCC Measures survey was distributed via REDCap to clinical leaders, followed by interviews with NICU teams to review survey scores and explore barriers to FCC implementation. The survey, co-developed by multidisciplinary clinicians and former NICU parents (family partners), encompasses the seven domains of FCC (see Table 1). Each question was assigned a numerical score. Independent t-tests examined differences in hospital distributions. ANOVA tests assessed score differences across hospital characteristics. Quantitative analyses were performed using SAS version 9.4. Qualitative interview data-analyzed by clinicians and family partners- used open coding to identify themes reflecting challenges in implementing FCC.

Results: Ninety-nine NICUs participated in the study (84 in the United States and 15 internationally), of which 45 elected to participate in interviews. Interview groups included between 1 and 25 multidisciplinary providers and family partners. Domain scores are presented in Table 1. No significant differences were observed between interviewed and non-interviewed NICUs, except the mean score for family integration into quality improvement was higher among the interviewed group.
The most commonly identified barriers to FCC implementation are summarized in Table 2. These included challenges related to recruiting family partners, providing mental health support, welcoming gestational siblings at the bedside, facilitating parental presence during shift change, and consistently using parents' preferred names. Interviews yielded actionable, context-specific strategies emphasizing dignity, respect, and collaboration. The effectiveness of these strategies will be reassessed at 6- and 12-month intervals.

Conclusion(s): This international assessment establishes a baseline of FCC performance across NICUs. Also, unit specific barriers to implementation and provided practical solutions. These insights offered a roadmap for advancing FCC implementation.

Table 1: Distributions of FCC Domains by Interview Status
Table 1 compares the mean and median scores of survey results for interviewed versus non-interviewed NICUs across the seven domains of FCC: (1) NICU framework and infrastructure, (2) family support, (3) family integration into care, (4) family integration into quality improvement (QI), (5) family-centered NICU environment, (6) staff education, and (7) process measures.

Table 2: Frequently Identified Barriers with Corresponding Potential Solutions
Table 2 summarizes the most frequently identified barriers along with corresponding potential solutions. The FCC Taskforce Research Team recognizes and appreciates the commitment of each participating NICU to strengthening and advancing their family-centered care (FCC) practices. The team also acknowledges the numerous challenges associated with implementing FCC comprehensively. These qualitative interviews aimed to generate actionable, solution-oriented strategies through an objective and inclusive process.