404 - Improving communication in the NICU: a qualitative descriptive study of parent and NICU clinician perspectives

Poster Number: 404
Publication Number: 404.135

Maya E. Dahan, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Leahora Rotteau, University of Toronto, Centre for Quality Improvement and Patient Safety, Toronto, ON, Canada; Wendy A. Moulsdale, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Giselle W. Lai, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Jennifer Stannard, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Jo-Ann Alfred, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kate Robson, Sunnybrook, Toronto, ON, Canada; Shelley Higazi, Sunnybrook Health Sciences Centre, North York, ON, Canada; Lisa Sampson, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Paige T. Church, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Karel O'Brien, Mount Sinai Hospital, Toronto, ON, Canada

Background: Individualized decision-making is based on clinicians better understanding of the context of families. Despite guidelines advocating for this type of decision making, there is no literature guiding its practical application by a multi-disciplinary team.

Objective: The purpose of this descriptive qualitative study is to explore the experience of families and NICU clinicians with information sharing around the families’ context and values, and how that applies to decision making in the NICU. Understanding how this is currently happening in our NICU will inform the development of a QI process aimed at improving communication between families and NICU clinicians.

Design/Methods: Using purposive sampling, families of varying cultural backgrounds and educational levels were recruited. We conducted semi-structured interviews with 11 parents from 8 families (3 couples chose to be interviewed together) and 13 NICU clinicians. We performed a thematic analysis on the interviews. Two authors (MD+LR) read the transcripts of the first four interviews of each group and performed a preliminary analysis to develop a coding structure. This coding structure was then used by one author (MD) to code the remainder of the transcripts.

Results: Four interconnected themes were identified both in the staff and family interviews: 1) the experience of sharing information, 2) the ‘broken telephone’ noted between NICU clinicians, 3) a strong desire to control information and 4) the positive impact of information sharing on care provided and received. These are shown in table 1.
One interesting difference elucidated in the interviews was that parents and staff placed different importance on certain decisions. Staff perceived important decisions as being those around goals of care. Parents viewed decisions like planning the timing of extubation (Family C) or choosing their infant’s first outfit once graduated to a crib (Family B) as decisions that they would like to be more involved in. This highlights opportunities for supporting parenting efficacy and building trust with families.Conclusion(s): This descriptive qualitative study serves as a first step in a larger quality improvement initiative aimed at improving communication between clinicians and families. These findings provide us with a better understanding of the dynamics of information sharing around a family’s context in our NICU and will help us target interventions to improve the experience for everyone involved. Improving this step will allow our NICU to engage in more family centered and individualized decision making.
Maya Dahan CV_ Summer2021.pdf