Staff Perception of a Family Communication Facilitator Intervention in the ICU: A Qualitative Study

Abstract

Background: More than 5000 Intensive Care Units (ICU) in the United States house the most critically ill patients of our health care system. These patients are often so sick they cannot make decisions for themselves. With little warning or preparation, family members become the surrogate decision makers in high stress environments. Communication issues with hospital staff rank high among the challenges these families face, and family dissatisfaction has been associated with poor communication. Improving communication between clinicians and families using a communication facilitator-- an additional staff member trained in mediation and communication--is the subject of an ongoing clustered randomized trial, the Family Communications Study (FSC). The FCS study recognizes that a key aspect of the success of their intervention is staff acceptance of the communication facilitators as a part of the clinical team. This thesis describes themes uncovered through semi-structured interviews with physicians, nurses and social workers who were familiar with the FCS study and who could provide us with in-depth descriptions of their reactions to the intervention. Methods: Fourteen semi-structured qualitative interviews were conducted with ICU physicians, nurses, and social workers who had experience with the communication facilitator intervention to assess their awareness of, attitudes towards, and perspectives on the intervention and the role of the facilitator. We used methods based on grounded theory to analyze the data. Results: We identified the following themes: 1) Staff perception of the facilitator role as facilitating communication between family and staff; 2) Staff perception of the facilitator role as providing practical and emotional support for the family; 3) Staff perception of the facilitator role as providing practical support for the staff ; 4) Staff interest in expanding facilitators' roles and responsibilities. Conclusions: Staff from all professions expressed equal enthusiasm about the idea of a communication facilitator. The staff viewed the facilitator as more than a conduit for information exchange but also playing a supportive role for families and staff. The interviews also suggested that team dynamic is extremely important, and the minority of staff expressing negative opinions about the facilitator need to be considered if the facilitation is to work.