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  • Original Article
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An interdisciplinary, family-focused approach to relational learning in neonatal intensive care

Abstract

Objective:

The aim of this study is to show the efficacy of the Program to Enhance Relational and Communication Skills–Neonatal Intensive Care Unit (PERCS-NICU).

Study Design:

In this study, 74 practitioners attended workshops and completed baseline, post-training and follow-up questionnaires.

Result:

On yes/no questions, 93 to 100% reported improved preparation, communication skills and confidence post-training and follow-up. A total of 94 and 83% improved their ability to establish relationships, and 76 and 83% reported reduced anxiety post-training and follow-up, respectively. On Likert items, 59 and 64% improved preparation, 45 and 60% improved communication skills and confidence, 25 and 53% decreased anxiety and 16 and 32% improved relationships post-training and follow-up, respectively. Qualitative themes included integrating new communication and relational abilities, honoring the family perspective, appreciating interdisciplinary collaboration, personal/human connection and valuing the learning. In total, 93% applied skills learned, three-quarters transformed practice and 100% recommended PERCS-NICU.

Conclusion:

After PERCS-NICU, clinicians improved preparation, communication and relational abilities, confidence and reduced anxiety when holding difficult neonatal conversations.

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References

  1. Yee W, Ross S . Communicating with parents of high-risk infants in neonatal intensive care. Paediatr Child Health 2006; 11: 291–294.

    PubMed Central  PubMed  Google Scholar 

  2. Williams C, Munson D, Zupancic J, Kirpalani H . Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care. A North American perspective. Semin Fetal Neonatal Med 2008; 13: 335–340.

    Article  PubMed  Google Scholar 

  3. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008; 36: 953–963.

    Article  PubMed  Google Scholar 

  4. Mack JW, Hilden JM, Watterson J, Moore C, Turner B, Grier HE et al. Parent and physician perspectives on quality care at the end of life in children with cancer. J Clin Oncol 2005; 23: 9155–9161.

    Article  PubMed  Google Scholar 

  5. Mulry C . I have an update…. Patient Educ Couns 2007; 65: 3–4.

    Article  PubMed  Google Scholar 

  6. Abbott KH, Sago JG, Breen CM, Abernathy AP, Tulsky JA . Families looking back: one year after discussion of withdrawal or withholding of life-sustaining support. Crit Care Med 2001; 29: 197–201.

    Article  CAS  PubMed  Google Scholar 

  7. Contro N, Larson J, Scofield S, Sourkes B, Cohen H . Family perspectives on the quality of pediatric palliative care. Arch Pediatr Adolesc Med 2002; 156: 14–19.

    Article  PubMed  Google Scholar 

  8. Javier A . How much emotion is enough. J Clin Ethics 2007; 18: 362–365.

    Google Scholar 

  9. Browning DM, Meyer EC, Brodsky D, Truog RD . Reflections on love, fear, and specializing in the impossible. J Clin Ethics 2007; 18: 373–376.

    PubMed  Google Scholar 

  10. Jellinek MS, Catlin EA, Todres TD, Cassem EH . Facing tragic decisions with parents in the neonatal intensive care unit: clinical perspectives. Pediatrics 1992; 89: 119–122.

    CAS  PubMed  Google Scholar 

  11. Fox S, Platt FW, White MK, Hulac P . Talking about the unthinkable: perinatal/neonatal communication issues and procedures. Clin Perinatol 2005; 32: 157–170.

    Article  PubMed  Google Scholar 

  12. Cuttini M, Nadai M, Kaminski M, Hansen G, deLeeuw R, Lenoir S et al. End-of-life decisions in neonatal intensive care. Lancet 2000; 355: 2112–2118.

    Article  CAS  PubMed  Google Scholar 

  13. Orfali K . Parental role in medical decision-making: fact or fiction? A comparative study of ethical dilemmas in French and American neonatal intensive care units. Soc Sci Med 2004; 58: 2009–2022.

    Article  PubMed  Google Scholar 

  14. Rebagliato M, Cuttini M, Broggin L, Berbik I, deVonderweid U, Hansen G et al. Neonatal end-of-life decision making: physicians’ attitudes and relationship with self-reported practices in 10 European countries. JAMA 2000; 284: 2451–2459.

    Article  CAS  PubMed  Google Scholar 

  15. Browning DM, Meyer EC, Truog RD, Solomon MZ . Difficult conversations in health care: cultivating relational learning to address the hidden curriculum. Acad Med 2007; 82: 905–913.

    Article  PubMed  Google Scholar 

  16. Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD . Difficult conversations: improving communication skills and relational abilities in healthcare. Pediatr Crit Care Med 2009; 10: 352–359.

    Article  PubMed  Google Scholar 

  17. Browning DM, Dokken DD . Speaking the Same Language. What Matters to Families. The Initiative for Pediatric Palliative Care Curriculum (Videotape Series). Education Development Center, Inc.: Newton, MA, 2002.

    Google Scholar 

  18. Lamiani G, Meyer EC, Browning DM, Brodsky D, Todres ID . Analysis of enacted difficult conversations in neonatal intensive care. J Perinatol 2009; 4: 310–316.

    Article  Google Scholar 

  19. Krippendorf K . Content Analysis: An Introduction to Its Methodology. Sage Publications: Newbury Park, CA, 1980.

    Google Scholar 

  20. Neuendorf K . The Content Analysis Guidebook. Sage Publications: Thousand Oaks, CA, 2002.

    Google Scholar 

  21. Manning P, Cullum-Swan B . Handbook of Qualitative Research. Sage Publications: Thousand Oaks, CA, 1994.

    Google Scholar 

  22. Kalet AL, Janicik R, Schwartz M, Roses D, Hopkins MA, Riles T . Teaching communication skills on the surgery clerkship. Med Educ Online 2005; 10: 16. Available from http://www.med-ed-online.org.

    Article  Google Scholar 

  23. Makoul G . Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001; 76: 390–393.

    Article  CAS  PubMed  Google Scholar 

  24. Kaplan SH, Greenfield S, Ware JE . Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989; 27: S110–S127.

    Article  CAS  PubMed  Google Scholar 

  25. Kalet AL, Pugnaire M, Cole-Kelly K, Janicik R, Ferrara E, Schwartz MD et al. Teaching communication in clinical clerkships: models from the Macy Initiative in Health Communications. Acad Med 2004; 79: 511–520.

    Article  PubMed  Google Scholar 

  26. Yedidia MJ, Gillespie CC, Kachur E, Schwartz MD, Ockene J, Chepatitis AE et al. Effect of communications training on medical student performance. JAMA 2003; 290: 1157–1165.

    Article  CAS  PubMed  Google Scholar 

  27. Wagner PJ, Lentz L, Heslop SD . Teaching communication skills: a skills-based approach. Acad Med 2002; 77: 1164.

    PubMed  Google Scholar 

  28. Kerr DN . Teaching communication skills in postgraduate medical education. J R Soc Med 1986; 79: 575–580.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Boss RD, Hutton N, Donohue PK, Arnold RM . Neonatologist training to guide family decision making for critically ill infants. Arch Pediatr Adolesc Med 2009; 163: 783–788.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA . Teaching communication skills to medical oncology fellows. J Clin Oncol 2003; 21: 2433–2436.

    Article  PubMed  Google Scholar 

  31. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med 2007; 12: 453–460.

    Article  Google Scholar 

  32. Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R . Efficacy of a cancer research UK communication skills training model for oncologists: a randomized controlled trial. Lancet 2002; 359: 650–656.

    Article  PubMed  Google Scholar 

  33. Lenzi R, Baile WF, Berek J, Back A, Buckman R, Cohen L et al. Design, conduct and evaluation of a communication course for oncology fellows. J Cancer Educ 2005; 20: 143–149.

    Article  PubMed  Google Scholar 

  34. Baile WF, Kudelka AP, Beale EA, Glober GA, Myers EG, Greisinger AJ et al. Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer 1999; 86: 887–897.

    Article  CAS  PubMed  Google Scholar 

  35. Fellowes D, Wilkinson S, Moore P . Communication skills training for health care professionals working with cancer patients, their families, and/or careers. Cochrane Database Syst Rev 2004; 2: CD003751.

    Google Scholar 

  36. Staples JK, Wilson AT, Pierce B, Gordon JS . Effectiveness of CancerGuides, a study of an integrative cancer care training program for health professionals. Integr Cancer Ther 2007; 6: 14–24.

    Article  PubMed  Google Scholar 

  37. Weiner JS, Cole SA . ACare: a communication training program for shared decision making along a life-limiting illness. Palliat Support Care 2004; 2: 231–241.

    Article  PubMed  Google Scholar 

  38. Singer Y, Carmel S . Teaching end-of-life care to family medicine residents—what do they learn? Med Teach 2009; 31: e47–e50.

    Article  PubMed  Google Scholar 

  39. Rao JK, Anderson LA, Inui TS, Frankel RM . Communication interventions make a difference in conversations between physicians and patients. Med Care 2007; 45: 340–349.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Erin Ward, MEd for her insight and gifted teaching. We are grateful to our talented actors who render their characters so genuinely and provide feedback with such care. We thank Allyson Wall, BA for her superb organization and professionalism and Kristina Fancy, BA for her editorial suggestions. We are indebted to our workshop participants for their willingness to share their learning experiences, vulnerabilities and discoveries. This study is dedicated to the memory of David Todres, MD, our beloved colleague, who will be long remembered for his inspired teaching and wisdom. This work was financially supported by the Argosy Foundation and the Department of Newborn Medicine, Children's Hospital Boston.

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Correspondence to E C Meyer.

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Meyer, E., Brodsky, D., Hansen, A. et al. An interdisciplinary, family-focused approach to relational learning in neonatal intensive care. J Perinatol 31, 212–219 (2011). https://doi.org/10.1038/jp.2010.109

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