Is it my turn to speak? An analysis of the dialogue in the family-physician intensive care unit conference.
Tessie W October, Zoelle B Dizon, Debra L Roter
PMID 29102443WHAT IT FOUND
In 39 pediatric ICU family conferences, clinicians spoke 73% of the average 45-minute conference, opened every discussion, and used denser, higher-reading-level speech than families.
Team-to-team talk excluded families for 26% of turns.
Key findings
01Clinicians dominated the conferences: they spoke 73% of the average 45-minute conversation, parents spoke 27%, and clinicians made every opening statement.
02Clinician speech was denser and harder to read: clinician turns averaged 6 statements and required about a 9th-grade reading level, while family turns averaged 2 statements and required about a 5th-grade reading level.
03Clinician-to-clinician talk excluded families: 26% of turns were between two or more clinicians, and more clinician turns were associated with higher reading-level demand and lower patient-centeredness.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It was one 44-bed PICU in a US tertiary center, so the dialogue patterns may not match other hospitals. Only English-speaking families were included, so it does not show how interpreter-mediated conferences sound. Families were not asked whether the turn length, turn density, or language complexity was appropriate or confusing. It analyzed only conference dialogue, not bedside or family-centered rounds conversations, so those may influence families too. Trainees were present, but the study did not measure how their presence influenced family comfort. It was cross-sectional, so correlations between more clinician turns and lower patient-centeredness do not show cause.
Declared interests
The article is tagged as NIH extramural research support. One author, Debra Roter, is the author of the Roter Interaction Analysis System and holds its copyright; Johns Hopkins University has rights to some enhancements. Neither she nor Johns Hopkins collects royalties for research use, including this study. She also owns RIASWorks LLC, a company providing RIAS coding services for non-university projects, which could benefit indirectly from dissemination. All other authors report no potential conflicts.
The easy way to misread this
Do not read these dialogue patterns as proof that changing turn-taking will improve family satisfaction or decision quality. The study did not measure family evaluations, clinical outcomes, or interpreter-mediated communication, and it was a single-center cross-sectional analysis.