Medical-Team Communication on Family-Centered Rounds and Caregiver Outcomes

BACKGROUND Family-centered rounds (FCR) offer opportunities to partner with families but can be inequitable with variable outcomes. Defining teachable communication practices associated with optimal FCR may improve family experience and engagement. OBJECTIVE To evaluate associations between clinician-team communication during FCR and caregiver outcomes in a racially and ethnically diverse population. METHODS We audio recorded and transcribed FCR. We double coded clinician-communication behaviors, assigned global communication ratings, and counted caregiver participatory behaviors (participation). Caregivers completed postrounds surveys, assessing comfort on rounds and understanding (correctly naming admission diagnosis). We assessed associations between clinician communication and caregiver participation using negative binomial regression. We assessed associations between clinician communication and caregiver-reported comfort and understanding using logistic regression. We adjusted for caregiver age, education, race, and ethnicity. RESULTS Sixty-one caregivers participated (20 white, 20 Black, 19 Latino(a/x), 2 multiracial). Caregiver participation was higher when clinicians used reflection (active listening) (incidence rate ratio IRR, 1.95) or supportive talk (IRR, 1.55) or had higher concern ratings (IRR, 1.58). Greater caregiver comfort was associated with clinician reflection (odds ratio OR, 5.31), information exchange (OR, 4.15), higher ratings of clinician flow (OR, 4.16), respect (OR, 6.25), and partnership (OR, 7.08). Caregiver understanding was higher with more clinician partnership-building (OR, 4.74), higher warmth (OR, 7.50), or partnership ratings (OR, 3.91). All P values were less than .05. DISCUSSION Several clinician-communication practices were significantly associated with caregiver outcomes. Significant clinician ratings and behaviors clustered into 2 domains: collaborative communication and emotional connection. Many clinician behaviors occurred rarely, highlighting possible time-efficient targets to improve family experience and engagement.