Communication intervention in the neonatal intensive care unit: can it backfire?

Abstract

Background: For parents of a critically ill infant, good communication may help alleviate stress and anxiety. To improve communication, physicians must be responsive to families' needs and values surrounding the care of their hospitalized infant.

Objective: We adapted a Decision-Making Tool for the Neonatal Intensive Care Unit (N-DMT) to encourage consideration of family concerns and preferences in daily care planning.

Design: This was a randomized controlled design.

Setting/subjects: Parents and providers of critically ill neonates were eligible. Parents were randomized to an intervention group (using the N-DMT) or standard of care. N-DMT information was shared through the electronic medical record and communicated directly to the primary provider.

Measurements: Daily rounds on all infants were audio recorded. Parents completed the State-Trait Anxiety Inventory at the first interview and 2 weeks later. Parents completed the Family Inventory of Needs-Pediatrics (FIN-PED) survey and an N-DMT-specific survey 2 weeks postenrollment.

Results: Complete data were obtained on 10 control and 9 intervention families. Groups did not differ on demographics or mean infant Score of Neonatal Acute Physiology (SNAP) scores (36 versus 37). FIN-PED scores were similar for both groups. The control group showed decreased anxiety over time. The content of rounds did not differ between groups. The intervention group reported lower satisfaction with care, specifically in questions regarding communication.

Conclusions: In this pilot study, we found that families in the intervention group were less satisfied with communication. Families who are primed to expect better communication, such as those participating in a communication intervention, may be less satisfied with standard care.