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Exploring Racial Differences in Family Expressions of Emotion and Clinician Empathy in ICU Family Meetings
Matthew E Modes1, Deborah B Ejem1, Whitney Welsh1
1AFFILIATIONS: From the Division of Pulmonary and Critical Care Medicine (M. E. M.), the Division of General Internal Medicine (T. K. N.), the Biostatistics Shared Resource (S. K.), Cedars-Sinai Medical Center, Los Angeles, CA; the School of Nursing (D. B. E.), University of Alabama at Birmingham, Birmingham, AL; the Social Science Research Institute (W. W., D. P., and J. S.), the Department of Population Health Sciences (K. I. P. and D. C. A.), the Division of Pulmonary and Critical Care Medicine (C. E. C. and D. C. A.), the Division of Geriatrics (K. S. J.), Department of Medicine, the Program to Support People and Enhance Recovery (C. E. C. and D. C. A.), the Duke-Margolis Center for Health Policy (D. C. A.), Duke University; the Cancer Prevention and Control Program (K. I. P.), Duke Cancer Institute; the Geriatrics Research Education and Clinical Center (K. S. J.), Durham Veterans Affairs Healthcare System, Durham; the Division of Pulmonary Diseases and Critical Care Medicine (S. S. C.), Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Division of Pulmonary, Critical Care and Sleep Medicine (E. K. K.), the Cambia Palliative Care Center of Excellence (E. K. K.), University of Washington, Seattle, WA; the Division of Pulmonary, Allergy, and Critical Care Medicine (C. L. H.), Department of Medicine, Oregon Health & Science University, Portland, OR; Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D. B. W.), and the Department of Critical Care Medicine (D. B. W.), School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Background:
Critical care guidelines recommend that clinicians provide emotional support to families of critically ill patients during family meetings. Little is known about how family member race impacts how emotions are expressed and supported in meetings.
Research Question:
Are there differences in family members' expression of emotion and clinicians' provision of empathy in ICU family meetings involving Black and White family members?
Study Design And Methods:
We conducted a directed content analysis of 40 audio-recorded meetings, matching 20 meetings with Black families and 20 meetings with White families on key characteristics including meeting length. Meetings included Black or White family members of patients receiving prolonged mechanical ventilation and critical care clinicians. We used an established coding scheme to code family expressions of negative emotion and clinician empathic statements. Two analysts, unaware of patient and family race, independently coded all meetings. After coding completion, we unmasked the data, compared code frequencies by family race, and calculated the percent of expressions of negative emotions followed by an empathic response.
Results:
Family members were mostly middle-aged (mean [SD], 50 [10] years) and women (n = 29 [73%]). Physicians leading meetings were mostly young (mean [SD], 38 [7] years), men (n = 27 [68%]), and White (n = 36 [90%]); none were Black. Black families expressed fewer negative emotions than White families (median, 1 [interquartile range, 0-3] vs 4 [interquartile range, 2.5-7.5] expressions of emotions per meeting; P < .001). When families expressed negative emotions, clinicians infrequently responded with empathy to all families and did so less frequently with Black families compared with White families (15% vs 30% of family expressions; P = .099).
Interpretation:
Our results indicate that racial differences exist in family expression of emotion and potentially in clinician empathic responses in ICU family meetings. Empathic communication warrants improvement, with greater improvement needed with Black families. Future interventions may be needed to enhance clinician provision of equitable emotional support.
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