Objective:

To examine clinician expressed empathy during neurocritical care family meetings and how different types of empathetic statements influence surrogate decision-making. 

Background:

When neurocritical care patients are unable to speak for themselves, empathy fosters a clinician-family relationship grounded in trust and respect. Although family meetings provide opportunities to discuss patient values and preferences, communication priorities often diverge. Understanding clinicians’ responses to family distress may identify communication strategies to support shared decision-making.  

Design/Methods:

We qualitatively analyzed 30 de-identified audio-recorded family meeting transcripts of an ongoing multi-center cross-sectional study using the internationally validated Verona Coding Definitions of Emotional Sequences (Vr-CoDES). Family and clinician utterances were coded using two complementary systems: (1) consensus definition of cues and concerns expressed by patients in medical consultations and (2) coding of health provider talk related to cues and concerns. Empathic statements initiated by clinicians without a preceding family cue/concern were coded and classified by their target (family or patient).   

Results:

Across 30 meetings, we identified a total of 178 total empathic statements, 150 clinician responses, and 58 clinician-prompted empathic statements. Family cues/concerns were present in 93.3% of meetings, 66.7% of which were family initiated. 26.7% of family cues involved explicit expressions of negative emotion, and 34% were indirect verbal hints to hidden concerns. 47.3% of clinician responses reduced emotional space for continued discussion, and 33.3% were non-explicit acknowledgement. The most frequent clinician response type was information/advice giving (38%); affective exploration or switching occurred the least often (1.3%). 

Conclusions:

Empathetic communication occurred in most NCCU family meetings, predominantly in response to family cues/concerns. However, many clinician responses reduced space for continued discussion of emotions by ignoring or by defaulting to informational explanations. These findings highlight opportunities to improve empathetic communication by promoting response styles that validate emotion and foster trust. Strengthening targeted empathic responses may improve both surrogate decision-making and family satisfaction.