Association between communication quality during ICU Family Meetings and Patient Health Outcomes

摘要 重症监护病房(ICU)患者的家属面临生死抉择，这是一种 压力很大，可能会导致不良的心理社会健康结果。临床医生沟通不畅 加剧代孕者的压力，阻碍决策，损害对临床医生的信任，并对医院征税 资源。多个大型、严格的随机对照试验在减少 代孕者的心理社会苦恼。而心理测量学上健全的调查问卷衡量的是沟通 质量，它们可能无法捕捉到动态的即时通信质量的细微差别，并且是可靠的 关于自我报告。因此，有必要进行理论上的、严谨的、客观的沟通 评估以更好地评估传播干预措施并阐明未来的有希望的方向 干预措施。这个项目的目标是应用一种创新的、理论驱动的方法来评估 称为通信质量分析(CQA)的通信，到已知的最大音频记录数据集 ICU家庭会议(R01HL094553)。CQA是由PIS合作伙伴Van Scoy和Scott开发的一种新方法 这是以多目标理论为基础的。该方法假设临床沟通涉及三个方面 目标类型：任务(例如，制定以患者为中心的护理决策目标)、关系(例如，肯定 临床医生-家庭关系)和身份(例如，尊重他人)。高质量的通信在以下情况下发生 对所有目标都给予关注；当忽略任何目标时，就会出现低质量的沟通。与许多不同的是 沟通措施，要么是自我评分的问卷，要么是评估沟通是否 行为发生时，CQA使用客观评级来评估目标实现的程度和程度。 我们以前的工作(R21NR017259)建立了在中国使用CQA的有效性、可行性和可靠性 评估模拟的临床医生与患者的接触。下一步是将分析应用于大型数据集 它由来自全美13个重症监护室的244个家庭会议录音组成，以描述Goal 注意并检查CQA分数是否与关键的健康结果相关。具体来说，我们的目标是：目标 1：描述在ICU家庭会议期间如何处理多个沟通目标 沟通质量分析在关怀讨论目标中的应用。当这一目标实现时，它将产生 ICU期间任务、关系和身份目标实现程度的第一个表征 家庭会议。目标2：评估CQA分数是否通过直接影响或 中介间接影响：治疗联盟(即代理人对医生的信任)、决策 结果(即决策冲突)和ICU利用率(即住院时间、插管时间)。如果成功， 这项研究将建立关于临床医生如何在家庭中关注理论推导的目标的基本知识 会议以及这种目标关注是否与关键的健康结果有关，这一点特别重要 在一个饱受阴性试验困扰的领域促进有效的干预发展。

ABSTRACT Family members of patients in the intensive care unit (ICU) face life and death decisions, an experience that is highly stressful and may lead to poor psychosocial health outcomes. Poor clinician communication exacerbates surrogates’ stress, impedes decision-making, damages trust in clinicians, and taxes hospital resources. Multiple large, rigorous, randomized controlled trials have been unsuccessful in reducing psychosocial distress of surrogates. While psychometrically sound questionnaires measure communication quality, they may fail to capture the nuance of dynamic, in-the-moment communication quality and are reliant on self-report. Thus, there is a need for a theoretically-grounded, rigorous, and objective communication assessment to better evaluate communication interventions and to shed light on promising directions for future interventions. The goal of this project is to apply an innovative, theory-driven method for assessing communication called Communication Quality Analysis (CQA), to the largest known dataset of audio-recorded ICU family meetings (R01HL094553). CQA is a novel methodology developed by co-PIs Van Scoy and Scott that is grounded in Multiple Goals Theory. The method assumes that clinical communication involves three types of goals: task (e.g., making patient-centered goals of care decisions), relational (e.g., affirming the clinician-family relationship), and identity (e.g., respecting others). High quality communication occurs when attention is given to all goals; low quality communication occurs when any goal is ignored. Unlike many communication measures that are either self-rated questionnaires or checklists that assess if a communication behavior occurs, CQA uses objective ratings to assess how well and the extent to which goals are achieved. Our previous work (R21NR017259) established the validity, feasibility, and reliability of using CQA in evaluating simulated clinician-patient encounters. The next step is to apply the analysis to a large dataset which consists of 244 audio-recorded family conferences from 13 ICUs across the US to characterize goal attention and examine if CQA scores are associated with key health outcomes. Specifically, our aims are: Aim 1: To characterize how multiple goals of communication are attended to during ICU family conferences by applying Communication Quality Analysis to goals of care discussions. When this aim is achieved, it will yield the first characterization of the extent to which task, relational, and identity goals are achieved during ICU family meetings. Aim 2: To assess if CQA scores are associated with outcomes through direct effects or mediated indirect effects on: therapeutic alliance (i.e., surrogate’s trust of physicians), decision-making outcomes (i.e., decisional conflict), and ICU utilization (i.e., length of stay, duration of intubation). If successful, this study will build essential knowledge about how clinicians attend to theory-derived goals during family meetings and whether this goal attention is associated with key health outcomes, which is especially important for facilitating effective intervention development in a field plagued by negative trials.