<p><strong>CONTEXT: </strong>Family meetings are encouraged in the pediatric cardiac intensive care unit (CICU) with the expectation of supporting parental shared decision-making (SDM). However, they often fall short of this goal. Additionally, interprofessional team and family meetings are dominated by input from physicians, under-utilizing the skillset of the full clinical team.</p>

<p><strong>OBJECTIVES: </strong>1) To determine feasibility of a codesign process to optimize the preparation of the interprofessional team and parents for conducting SDM-oriented family meetings in the CICU, and 2) to describe the resulting elements of the intervention including new support documents for the team and family to prepare for the meeting, team member roles in the meeting, and optimization of communication skills.</p>

<p><strong>METHODS: </strong>Experience-based codesign was used with CICU clinicians and parents of children hospitalized in the CICU to develop an intervention at a single institution. Sessions were audio recorded and transcribed and analyzed using modified grounded theory. Participants were surveyed about their engagement in the codesign process to assess feasibility.</p>

<p><strong>RESULTS: </strong>Fifteen professionals and 6 parents enrolled in the codesign and endorsed engagement in the process and importance of the intervention elements. Participants identified the benefit of complementary parent and team preparation for family meetings noting 5 distinct types of meetings that occurred frequently. Documents, processes, and skills training were developed to improve interprofessional teamwork regarding shared decision making and support of parents in family meetings.</p>

<p><strong>CONCLUSION: </strong>A codesign of an intervention with clinicians and parents in the CICU is a feasible and resulted in an intervention with broad support among clinicians in the CICU.</p>

<p>Family meetings, which bring together members of a seriously ill patient's family and the interprofessional team (IPT), have been widely recognized as promoting shared decision making for hospitalized patients, particularly those in intensive care units. The planning and conducting of interprofessional family meetings is hampered, however, by a lack of clarity about who is doing what and when, which in turn can lead to inefficiencies and uncoordinated efforts. This manuscript describes how members of the IPT interact with one another (what we have termed team-team practices), distinguishing these interactions from how the IPT engages directly with family members (team-family practices) in preparing for and conducting family meetings. While most research and guidelines have focused on team-family practices that directly affect patient and family level outcomes (e.g., safety and satisfaction), team-team practices are needed to coordinate team contributions and optimize the skills of the diverse team. Team members' knowledge and attitudes also contribute to patient and family outcomes as well as team outcomes. Yet without attention to team-team practices prior to, during, and after a family meeting, the family level outcomes are less likely to be achieved as are team wellbeing outcomes (e.g., reduced burnout and staff retention). Drawing upon team theory, we present a set of key concepts and corresponding terms that enable a more precise description of team-team practices as well as team-family practices, aiming to help with team training and evaluation and to enable future research of these distinct yet inter-related practices.</p>

<p><strong>CONTEXT: </strong>Interprofessional teams often develop a care plan prior to engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics, but that has not been studied.</p>

<p><strong>OBJECTIVES: </strong>To characterize the types of interactions that interprofessional team members have in pre-family meetings huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision-making.</p>

<p><strong>METHODS: </strong>We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings prior to care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision-making using the CSACD questionnaire.</p>

<p><strong>RESULTS: </strong>Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); non-physicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and non-physician perceptions of collaboration were found in 3 out of 10 observed meetings.</p>

<p><strong>CONCLUSIONS: </strong>Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings.</p>

<p><strong>BACKGROUND: </strong>Parents of children in the pediatric cardiac intensive care unit (CICU) report inadequate communication and a lack of empathy during conversations with their clinicians.</p>

<p><strong>OBJECTIVE: </strong>To assess quantitatively and qualitatively the contributions made by team members of different professions in communicating with parents during family meetings.</p>

<p><strong>DESIGN: </strong>Prospective observational study.</p>

<p><strong>SETTING/SUBJECTS: </strong>The pediatric CICU at the Children's Hospital of Philadelphia. Subjects were members of the interprofessional team attending family meetings for patients admitted to the CICU longer than two weeks.</p>

<p><strong>MEASUREMENTS: </strong>We used quantitative conversation attribution and coding to compare durations of attendee contributions and contribution type by professional role. The SCOPE codebook and other quantitative codes drawn from best practices in family meetings were used to measure communication behaviors. A qualitative analysis of nurses' and social workers' contributions was used to identify themes not otherwise captured.</p>

<p><strong>RESULTS: </strong>Across 10 meetings, physicians spoke for an average of 78.1% (SD 10.7%) of each meeting, non-physicians 9.6% (SD 7.8%), and parents 17.4% (SD 12.2%). Parental understanding was assessed an average of 0.2 (SD 0.4) times per meeting. Parents expressed emotion an average of 4.2 times per meeting (SD 7.1) and the clinical team responded empathetically 2.2 times per meeting (SD 4.3). All clinician empathic responses were a minority of their overall contributions. Conversation was almost exclusively between physicians and families until physicians indicated other team members could contribute.</p>

<p><strong>CONCLUSIONS: </strong>Coordination of team members' roles in the meetings may improve parental engagement necessary for decision-making and empathic responses that are often missed.</p>