Beyond satisfaction: evaluating understanding in PICU family centered rounds

ABSTRACT

Background

Many hospitals have adopted Family Centered Rounds (FCR), as a means to optimize communication. While studies show FCR improves family satisfaction, research on the impact on family understanding of their child’s care has been conflicting. Understanding is particularly important when families are asked to share in complex decision making, as occurs in the Pediatric Intensive Care Unit (PICU). This study explores families’ experiences of FCR in the PICU and examines how FCR impacts their understanding of their child’s care.

Methods

We conducted surveys and interviews of family members after they attended FCR in two PICUs. The survey assessed families’ satisfaction with rounds and their understanding across three domains: the child’s illness, treatments, and prognosis. Physicians completed a similar survey to examine concordance with families’ understanding. In interviews we explored underlying factors. We identified themes from transcripts through thematic analysis.

Results

Twenty-five family members completed the survey and participated in interviews. The majority (82%) rated their satisfaction with FCR highly. Discordance between families and physicians in understanding was common, especially in the prognosis domain, with concordance rates as low as 27%. We identified four themes from interviews that shed light on families’ experiences and the relationship between FCR and understanding: Jargon, Feeling Part of the Team, Rounds as Overwhelming and Competing Purposes of Rounds.

Conclusion

Families in our study had similar satisfaction with FCR as previously reported, yet our findings suggest that FCR can be optimized to achieve family understanding. Our findings provide insights into potential ways to accomplish this.

KEYWORDS:

• Teaching rounds
• communication
• intensive care units
• pediatric
• prognosis
• decision making
• patient-centered care
• family

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

April Edwell

April Edwell, MD is a Pediatric Critical Care Fellow at the University of California San Francisco (UCSF).

Sandrijn van Schaik

Sandrijn van Schaik, MD PhD is a Professor of Pediatrics at the University of California San Francisco (UCSF) and Baum Family Presidential Chair for Experiential Learning. She completed an Education Research Fellowship at UCSF and has expertise in interprofessional teamwork and communication. She has a clinical appointment at UCSF Benioff Children’s Hospital through the Division of Pediatric Critical Care Medicine.

Mansi Desai

Mansi Desai, MD is an Assistant Professor in the Department of Pediatrics at the University of California, San Francisco (UCSF). She is a hospitalist and is the Director for Medical Education for the Division of Hospital Medicine.