Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study

Objectives: To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations. Research methodology/Design: Mixed-methods survey study. Setting: Two medical ICUs of a German academic tertiary care hospital. Main outcome measures: Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis. Findings: The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p=.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p=.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p=.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest. Conclusion: The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit. Implications for clinical practice: Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.