BACKGROUND AND OBJECTIVES:

Parents’ ideas about what it means to be a “good parent” to their seriously ill child influence parental decision-making. Little is known about when, why, and how clinicians offer good-parent praise or how parents react. Our objective was to describe clinicians’ spontaneous use of good-parent praise statements to parents during PICU care conferences and how parents respond.

METHODS:

Single-center, cross-sectional review of 72 transcripts of audio-recorded PICU care conferences in a quaternary medical center. Qualitative analysis was conducted to code triggers for clinician good-parent statements and parent responses.

RESULTS:

Clinicians made at least one statement of good-parent praise in 32% of family conferences. Triggers for clinician statements of good-parent praise were categorized into 6 themes: decision making, gratitude to the clinical team, defense of parenting, parental body language, parental guilt, and intention to close the meeting. Parental responses to clinician statements of good-parent praise fell into 6 themes: acknowledgment, medical talk, deepening of feelings expressed in conversation, focusing on a decision, redirecting on the patient, and gratitude.

CONCLUSIONS:

Clinicians spontaneously praised parents for their role in being a good parent in less than one-third of family conferences. Clinician statements were triggered by verbal and nonverbal parental behaviors, a critical decision-making point in the conversation, and an intention to close the meeting. In response, parents frequently responded positively to the praise and often returned the gratitude or reflected on their feelings about caregiving for their child.

Clinicians (physicians, social workers, nurses, and others) convene care conferences with families of critically ill children in the PICU to review a patient’s condition, discuss prognosis, and make important medical decisions.1,2  To best support parents and align with their values, clinicians need to build rapport in a way that establishes mutual respect and trust. This is especially important when families are faced with considering unimaginable decisions, such as the withdrawal of technological support. Empathy statements come in many forms, including support statements and naming the emotion.2  One promising way to convey empathy and build rapport is by offering praise to parents and other family members regarding the ways in which they are parenting and caring for their seriously ill children. Such feedback can significantly influence parents’ experiences of these conversations as well as the decisions they make for their children.3,4 

The concept of “good parent” was first articulated by parents of a child with incurable cancer in 2005.5,6  The Good-Parent Beliefs concept4  has been explored and validated in a variety of pediatric clinical settings, including the PICU,3  complex chronic care clinics and services,7  and pediatric oncology phase I clinical trials,8  as well as longitudinally, as families travel their children’s illness trajectories9  and specifically from the paternal perspective.10,11  When curative treatment options have been exhausted, the reassurance that parents are fulfilling their role well can help parents make clinical decisions and feel satisfied with those decisions,6  at times improving care interactions and psychosocial outcomes for families.12  Good-parent beliefs are recognized as a guiding compass in parental decision-making and are central to a parental sense of personal duty.12  In research, it is suggested that, for parents, being a good parent includes making informed, unselfish decisions in the best interest of the child; physically staying at the child’s side; advocating for the child to clinical staff; maintaining personal strength to accompany the child physically and emotionally; providing for the child’s basic needs (eg, food, shelter, and clothing); teaching the child respect, sympathy, and how to make good decisions; and ensuring that the child knows that they are loved.6,7 

The body of literature in which researchers examine the concept of being a good parent reveals the value that parents of seriously ill children find in taking on a good-parent role. In parallel, we know that clinicians find value in understanding parents’ notions of what it means to be a good parent, so they can support parents in playing such a role.13  After reviewing transcripts of recorded PICU care conferences, we noticed that clinicians spontaneously offer statements of praise regarding parents’ roles. This led us to recognize a significant gap in our knowledge of the context and ways in which clinicians offer such praise to parents. The objectives of this study were to describe the presence, frequency, and types of good-parent praise clinicians spontaneously convey to parents during PICU care conferences and identify family responses to the clinician good-parent statements.

We conducted a single-center, cross-sectional, qualitative study in which we analyzed 72 transcripts of family-clinician care conferences in the PICU. These care conferences were all centered around major decisions, including tracheostomy placement, other medical or surgical steps, changes in goals of care, or withdrawal of technological support. Transcripts were collected between 2015 and 2019, in an urban, quaternary medical center with a 44-bed mixed medical and surgical PICU, excluding patients with primary cardiac conditions (who were cared for in a separate pediatric cardiac ICU). These transcripts were collected as part of a larger study that aimed to understand how clinicians communicate with families during decision-making family conferences,2  and this study is a secondary analysis of that parent study.

The methods for data collection from the parent study are described in a previous article.2  In summary, a care conference was defined as a scheduled meeting between the parent(s) or other primary caretaker(s) (ie, grandparent) of a critically ill child (newborn to 26 years of age), the PICU attending physician or primary consultant, and other members of the clinical team (ie, other subspecialists, social workers, and nurses), in which the clinical team discussed treatment options with an English-speaking family member of a critically ill child. Medical decisions were defined as resolutions to initiate, escalate, or withdraw medical interventions (ie, endotracheal tubes, extracorporeal membrane oxygenation, and surgical procedures), as well as conversations and resolutions regarding resuscitation status. Each care conference was audio recorded and transcribed verbatim, with personal identifiers removed before analysis. We collected demographic data from families via surveys, clinical data from patients via electronic health record, and demographic data from clinicians via surveys. Written informed consent was obtained from study participants.

A good-parent praise statement was defined as any statement made by a clinician that attempted to convey to the parent(s) or other primary caretaker(s) appreciation for their role in caring for their critically ill child. An example of good-parent praise statement is the following: “I know that this is so hard, and I can see the strain on your face, but I have to commend both of you for the absolute strength and resilience you have shown through this entire process. I’ve only worked with you for three days, but, just knowing the course that your child has been through and seeing where you guys are, she’s very lucky to have you as parents.” In addition to identifying the good-parent praise statement, we coded both triggers and responses to the statement. A trigger was defined as the statement or interaction immediately preceding the good-parent praise statement. A response was defined as a statement from the parent or another clinician that directly followed the clinician good-parent praise statement.

We conducted thematic analysis to code clinician statements of good-parent praise to parents or other family members in care conferences as well as the family or clinician responses to these statements. We applied directed content analysis on the basis of Consolidated criteria for Reporting Qualitative Research guidelines to code the good-parent praise statements and clinician or family responses to those statements.14  We used investigator triangulation, with 2 investigators reviewing all transcripts and 3 reviewing all codes. Any discrepancies in coding were resolved through discussion until consensus was reached.

The 72 care conferences involved families of 71 patients, totaling 185 family members (a mean of 2.6 parents or family members per conference) and 30 clinicians (a mean of 6 clinicians per conference; Table 1). Clinicians included physicians, social workers, case managers, and bedside nurses. Palliative-care physicians were present at 15 of the 72 conferences (21%). Conferences ranged from 19 to 137 minutes (median of 39 minutes). Patients carried diagnoses addressed by a variety of pediatric subspecialties, and care-conference discussions were focused on a range of key decisions, including tracheostomy (44%), overall goals of care (20%), surgical procedures (14%), medical procedures (13%), and withdrawal of technical support (9%). Family members were 43% male and 57% female, including 38% mothers, 29% fathers, and 34% other family members (including aunts, uncles, or siblings, who were not the primary caretaker or parent).

TABLE 1

Demographic Characteristics of Care Conference Participants

Patients (n = 71), n (%)Family Members (n = 185), n (%)Clinicians (n = 30), n (%)
Characteristics    
 Male 43 (59) 80 (43) 13 (43) 
 Age, mo, median (IQR) 42.5 (14.8–120.0) — — 
Race    
 Black 44 (62) 110 (59) 2 (7) 
 White 16 (23) 45 (24) 24 (80) 
 Asian 11 (15) 30 (16) 4 (14) 
Diagnosis    
 Hematology-oncology 15 (21) — — 
 Respiratory 15 (21) — — 
 Neurologic 14 (20) — — 
 Congenital and/or genetic 12 (17) — — 
 Shock and/or trauma 8 (11) — — 
 Other 7 (10) — — 
Treatment decision discussed    
 Tracheostomy 31 (44) — — 
 Overall goals of care 14 (20) — — 
 Surgical procedure 10 (14) — — 
 Medical procedure 9 (13) — — 
 Withdrawal of technology 6 (9) — — 
Disposition    
 Home 31 (44) — — 
 Rehabilitation 19 (27) — — 
 Deceased 16 (23) — — 
 Other hospital 4 (6) — — 
 Hospice 1 (1) — — 
Relationship to patient    
 Mother — 70 (38) — 
 Father — 53 (29) — 
 Other family member — 62 (34) — 
Medical specialty    
 Critical care — — 10 (33) 
 Hematology-oncology — — 7 (23) 
 Neurology — — 2 (7) 
 Pulmonology — — 2 (7) 
 Other — — 4 (14) 
Years of practice    
 <5 — — 6 (20) 
 >5 — — 24 (80) 
Patients (n = 71), n (%)Family Members (n = 185), n (%)Clinicians (n = 30), n (%)
Characteristics    
 Male 43 (59) 80 (43) 13 (43) 
 Age, mo, median (IQR) 42.5 (14.8–120.0) — — 
Race    
 Black 44 (62) 110 (59) 2 (7) 
 White 16 (23) 45 (24) 24 (80) 
 Asian 11 (15) 30 (16) 4 (14) 
Diagnosis    
 Hematology-oncology 15 (21) — — 
 Respiratory 15 (21) — — 
 Neurologic 14 (20) — — 
 Congenital and/or genetic 12 (17) — — 
 Shock and/or trauma 8 (11) — — 
 Other 7 (10) — — 
Treatment decision discussed    
 Tracheostomy 31 (44) — — 
 Overall goals of care 14 (20) — — 
 Surgical procedure 10 (14) — — 
 Medical procedure 9 (13) — — 
 Withdrawal of technology 6 (9) — — 
Disposition    
 Home 31 (44) — — 
 Rehabilitation 19 (27) — — 
 Deceased 16 (23) — — 
 Other hospital 4 (6) — — 
 Hospice 1 (1) — — 
Relationship to patient    
 Mother — 70 (38) — 
 Father — 53 (29) — 
 Other family member — 62 (34) — 
Medical specialty    
 Critical care — — 10 (33) 
 Hematology-oncology — — 7 (23) 
 Neurology — — 2 (7) 
 Pulmonology — — 2 (7) 
 Other — — 4 (14) 
Years of practice    
 <5 — — 6 (20) 
 >5 — — 24 (80) 

IQR, interquartile range; —, not applicable.

Clinicians offered good-parent praise statements only 32% of the time (23 care conferences), totaling 31 good-parent praise statements in 72 conferences. The palliative-care team was present for 8 of 23 (35%) care conferences in which good-parent praise statements were offered. We identified triggers for good-parent praise statements and classified them into 6 themes, 4 of which were parental cues, either verbal (defense of parenting, parental guilt, or gratitude to the clinical team) or nonverbal (parent body language, perceived on the basis of crying on the recording or discerned via comments made by the clinical team; Table 2). The remaining triggers were clinician desire to discuss decision-making or close the meeting.

TABLE 2

Good-Parent Statement Triggers

TriggerCode DefinitionCountExample
Decision-making Discussion of plans for next steps in clinical care 16 Physician: It seems to you like we keep asking you why, you know, what you want. You’re the primary: she’s yours and that’s your decision to make… That’s why we keep coming back to you and wanting you to really, because when she gets home it’s going to be the two of you, and you have to agree on how you’re going to care best for her. 
Gratitude toward team Family member expresses thanks and/or appreciation to clinical caregivers Parent: It’s the opportunity…to be here for most morning rounds and evening rounds and being able to hear and actually be engaged. It’s a moment where you appreciate what’s being done for him. 
Defense of parenting Family member explains decision, role as parent, approach, or coping strategy Parent: Last year, when he was in coma, doctors said…even though he wakes up, he’s going to be brain dead. He went home; he understands what’s going on; he’s been answering us; he enjoys his friends’ visit; he smiles at jokes: he was not brain dead. How can we decide he was brain dead? 
Body language Family member exhibits specific visible and/or audible emotions noted by clinician Parent: (crying) It’s not fair children have to go through this. They haven’t even lived, you know? 
Parental guilt Family member alludes to feelings of inadequacy or wishing to do better in their caregiving role Physician: You should not blame yourself, and I know you know that. I know you know that. 
Parent: But I did, I did leave him… 
Close Clinician offers statement as an end to the family meeting Social worker: Well, thank you so much for coming today to have this conversation… We know it wasn’t easy. 
TriggerCode DefinitionCountExample
Decision-making Discussion of plans for next steps in clinical care 16 Physician: It seems to you like we keep asking you why, you know, what you want. You’re the primary: she’s yours and that’s your decision to make… That’s why we keep coming back to you and wanting you to really, because when she gets home it’s going to be the two of you, and you have to agree on how you’re going to care best for her. 
Gratitude toward team Family member expresses thanks and/or appreciation to clinical caregivers Parent: It’s the opportunity…to be here for most morning rounds and evening rounds and being able to hear and actually be engaged. It’s a moment where you appreciate what’s being done for him. 
Defense of parenting Family member explains decision, role as parent, approach, or coping strategy Parent: Last year, when he was in coma, doctors said…even though he wakes up, he’s going to be brain dead. He went home; he understands what’s going on; he’s been answering us; he enjoys his friends’ visit; he smiles at jokes: he was not brain dead. How can we decide he was brain dead? 
Body language Family member exhibits specific visible and/or audible emotions noted by clinician Parent: (crying) It’s not fair children have to go through this. They haven’t even lived, you know? 
Parental guilt Family member alludes to feelings of inadequacy or wishing to do better in their caregiving role Physician: You should not blame yourself, and I know you know that. I know you know that. 
Parent: But I did, I did leave him… 
Close Clinician offers statement as an end to the family meeting Social worker: Well, thank you so much for coming today to have this conversation… We know it wasn’t easy. 

The most common trigger for a good-parent praise statement was anticipation of the need to determine the next steps in treatment, which we labeled as “decision-making.” For example, a social worker articulated a family’s need to decide whether the patient should be transferred to a rehabilitation facility, while also conveying good-parent praise: “And I have to say the discussion that you’re seeming to have with yourself about trying to figure out what’s the best place for her, convenience aside… I feel like your family motivation is so strong that, wherever you end up, she’s going to do great.”

In addition to coding triggers for clinician good-parent statements, we identified family or clinician responses to the good-parent praise. Six themes emerged, which we then further characterized into categories of acceptance and nonacceptance. Acceptance of the good-parent praise was defined as responses from the family that conferred positive reception and included themes of acknowledgment, deepening of emotion, statement of a decision, or expression of gratitude for the good-parent statement (Table 3). Of the responses to good-parent praise identified, 65% were acknowledged by the parent or family member. Conversely, 35% of the time, the good-parent statements were not acknowledged by the family. In these cases, family members either continued to talk about medical facts (coded as “medical talk”) or returned their attention to their child’s experience rather than focusing on the parent’s role (coded as “refocusing on patient”). Statements offered while attempting to make clinical decisions were commonly followed by continued talk about medical details, neither family nor clinicians leaving space for acknowledgment and acceptance of the praise. In one discussion, a physician followed a good-parent praise statement with a return to possible clinical scenarios. The patient’s father responded with only an acknowledgment of “yeah,” seemingly indicating that he is following the physician’s explanation, before the physician continued explaining possible outcomes after extubation.

He has what we call respiratory failure. …this is likely related to his brain, which is related to the Alexander’s disease, which is kind of a known progression of his disease. And then the question will be, “what are the next steps?” And I know the complex care doctor had talked to you guys a lot about that yesterday…

PICU physician

What we talked about is basically what we call “loving choices.” I mean it is so clear that WB is so loved. I mean it’s just amazing to see, and it’s heartwarming for everyone. So what we’re trying to decide is, depending on what he does, and we really don’t know – if we knew we would tell you – but we don’t really know how he’s going to do when we extubate him, what is the best thing for WB, depending on which way he goes.

Complex-care physician

Yeah.

Father

So as much help as he needs, and then gradually pull back our help. Then hopefully he’ll be back to where he was, with a little bit worsening of the disease, some new medicines, but hopefully doing okay.

Complex-care physician

TABLE 3

Good-Parent Statement Responses

ResponseCode DefinitionCountExample
Acknowledgment Family member directly recognizes and/or accepts clinician statement 13 Parent: I’m trying. 
Medical talk Family member or clinician continues with technical language or question 10 Grandparent: Can’t you treat [it] because the Hodgkin’s is supposedly gone? 
Deepening Family member shares emotions, hopes, fears, etc. Parent: Last question on my mind, I hear the word “home,” and I get terrified. 
Focusing on the decision Family member or clinician makes or restates a determination of next steps on the basis of the family’s decision Grandparent: I’m going back to the DNR… Allow Natural Death, that’s it. 
Refocusing on the patient Family member returns attention to child (child’s strength/inspiration OR suffering/pain) Parent: You know, she’s been through so much for so many months, I know mentally she’s strong willed. God, she’s just a true inspiration… But just her poor body, it’s just gone through so much and [is] still going through so much. And to come this far, I know she’s not giving up or mentally lost: no way. That’s just not her. She’s going to fight until she walks out of here, that’s just the way she is. 
Gratitude Family member expresses thanks toward health care team Parent: Thank you. And I’ve had some help also too; I’ve been blessed in my home to have excellent care from the home-help services. 
ResponseCode DefinitionCountExample
Acknowledgment Family member directly recognizes and/or accepts clinician statement 13 Parent: I’m trying. 
Medical talk Family member or clinician continues with technical language or question 10 Grandparent: Can’t you treat [it] because the Hodgkin’s is supposedly gone? 
Deepening Family member shares emotions, hopes, fears, etc. Parent: Last question on my mind, I hear the word “home,” and I get terrified. 
Focusing on the decision Family member or clinician makes or restates a determination of next steps on the basis of the family’s decision Grandparent: I’m going back to the DNR… Allow Natural Death, that’s it. 
Refocusing on the patient Family member returns attention to child (child’s strength/inspiration OR suffering/pain) Parent: You know, she’s been through so much for so many months, I know mentally she’s strong willed. God, she’s just a true inspiration… But just her poor body, it’s just gone through so much and [is] still going through so much. And to come this far, I know she’s not giving up or mentally lost: no way. That’s just not her. She’s going to fight until she walks out of here, that’s just the way she is. 
Gratitude Family member expresses thanks toward health care team Parent: Thank you. And I’ve had some help also too; I’ve been blessed in my home to have excellent care from the home-help services. 

DNR, do not resuscitate.

Notably, the father begins to cry during this exchange, communicating his emotion around the anticipated decision nonverbally.

Good-parent praise statements emerged in conversation in a variety of ways, from clinicians of multiple disciplines, woven in at different points in the conferences, and in response to multiple triggers. Somewhat unexpectedly, we did not find patterns between specific decision triggers and decision responses; in fact, the “decision-making” trigger was not associated with the “focusing on a decision” response. Despite such variation, interactions tended to take on the rhythm of a back-and-forth exchange between clinicians and families (Fig 1).

FIGURE 1

Example of a good-parent praise statement and family response exchange.

FIGURE 1

Example of a good-parent praise statement and family response exchange.

Close modal

For the most part, good-parent praise statements from clinicians to family members provided essential support to families at crucial decision-making moments and under tremendous stress. Nonetheless, as we completed the analysis, we witnessed several moments of what has been described in the psychology literature as “nudging,” in which clinicians offered praise as affirmation when a family member demonstrated movement toward a particular decision that seemed to align with the clinical team’s preferences for the patient.15  In the following example, a grandmother is ambivalent around 2 important decisions: (1) tracheostomy placement and (2) code status. The health care team offers good-parent praise after the grandmother affirms the team’s preferences for less intervention.

What is the tracheostomy changing for her in the long run? What are we hoping to accomplish with the tracheostomy? We’re not changing her scoliosis. We’re not changing her lungs. We’re not changing her risk of infections. So sometimes it helps to think of it from that point too.

Complex-care physician

Maybe that wouldn’t be the choice for you, and that’s okay.

Complex-care team

You mentioned yourself too. You love her so much, and you take such good care of her, but we want you to be able to feel comfortable with whatever path we make and not feel like you can’t have a moment’s rest.

PICU fellow

I’m going to stick with the medicines to help the breathing because I can’t handle the tracheostomy thing right now.

Grandmother

This is actually really strong of you. It’s a very loving, very strong decision.

Palliative-care team

It’s very brave and strong.

PICU fellow

Later in the conversation…

If a child is going to suffer in our hands, it has to be for some darn good reason, and it’s going to have to be able to help them and make them feel better. And we know we’re at that point that…

PICU physician

It’s not going to make her better.

Grandmother

Right.

PICU physician

I’ll go back to the DNR.

Grandmother

You have made all the loving choices.

Palliative-care physician

Although the dynamic here is not coercion, it certainly provides positive feedback immediately after the grandmother’s decision to change the code status to “Allow Natural Death,” as the care team has recommended.

Clinicians offered spontaneous praise to parents and families of critically ill children infrequently while meeting in PICU care conferences. In fact, praise statements were used less frequently than anticipated, in only 32% of conferences. Such praise can influence families’ experiences of the care conferences and the decisions that emerge from the discussions, in that praise has the potential to encourage or discourage families from moving forward with next steps in a plan of care. Although we cannot speculate on clinicians’ motivations for using good-parent praise statements, we noted that clinicians frequently used good-parent praise statements in anticipation of and preparation for the discussion of a critical decision. Clinicians also used them in response to a family cue, such as parental expression of guilt or demonstration of another emotion. It is notable and laudable that clinicians identified family members’ emotions, paused, and reacted to them with empathy.

Our analysis revealed that good-parent praise is effective at conveying empathy and positive feedback. Most of the time, family members responded by acknowledging the praise and expressing gratitude, either returning praise to the clinical team or expressing emotion in response to the praise. At times, however, a family member refocused attention on the seriously ill child, or either the family member or a member of the team continued speaking about the medical details, without attending to the praise conveyed. Although less frequent than the more connecting and affirming alternative, we see these moments of unrecognized praise as missed opportunities for connection between families and the clinical team.

A question that we returned to throughout our analysis was how to analyze and understand the work that a good-parent praise statement offered by a clinician to a family member does in a care conference. We found that, when acknowledged, good-parent praise statements reassured families that decisions they were making were in the best interest of their child (even when families did not finalize a decision during the conversation at hand), comforted families that what they were doing was in the best interest of their child, and absolved parents of guilt around caring for and deciding for their child. These 3 feats are significant: families of seriously ill children engaged in PICU care conferences face daunting decisions, the experiences and outcomes of which will no doubt affect their future reflections on and satisfaction with their decision-making experiences. Permission, reassurance, and absolution are noteworthy manifestations of support for those families from the clinical team during these critical moments.

As described above, we observed moments of “nudging,” in which clinicians offered good-parent praise statements as affirmation when a family member demonstrated movement toward a particular decision that the clinical team deemed to be in the best interest of the patient. Although the phenomenon of nudging is far from outright coercion, we want to both caution ourselves and offer warning to our fellow clinicians that it occurs. Of course, helping a family understand their choices is important, but there is a fine balance between making a recommendation and pushing family toward a particular decision. Understanding a family’s values and preferences forms the foundation of critical decision-making.16  It is only when we firmly understand these values that we can make a family-centric recommendations for care.

This qualitative analysis was limited by being a secondary analysis, based on transcripts and, therefore, removed from the real-time dynamics of care conferences. Although some nonverbal cues were documented within the transcript (such as crying or periods of silence), many were not discernable on the basis of the written transcript. Furthermore, the study did not survey families or clinicians after the care conferences to determine their satisfaction with the encounters. Doing so would have allowed us to evaluate whether good-parent praise statements influence clinician and parent experiences of care conferences and of decision-making in PICU settings. Only English-speaking families were included in this study, and this inclusion criterion may have influenced the uptake of and engagement with good-parent praise. From an anthropological perspective, families from different countries and contexts may use different frameworks for communicating praise, rather than the direct statements focused on acts of care or expressions of love that we focused on in this study.

One notable limitation of this analysis was our inability to gauge the intent of good-parent praise statements, discerning between deep affirmation and superficial platitude. It is possible that some parents did not acknowledge good-parent praise statements because the parent found a statement insincere or even condescending. Of course, in other instances, a parent may not have acknowledged it because that parent doubted their own parenting and was not in a place to received sincere praise. In light of the fact that we were unable to differentiate between these situations in our analysis, we caution ourselves and our colleagues to only offer good-parent praise statements when spoken in sincerity, recognizing that such affirmations are sacred and should not be spoken without true sentiment behind them.

Despite these limitations, this study’s strengths lie in its nonsimulated, qualitative methodology. By using qualitative analysis of actual clinician-family interactions to understand when and how clinicians use spontaneous expressions of parental praise in talking with families, its findings are more representative of live care conferences than studies that employ clinical communication simulations to analyze good-parent praise. It also includes representative samples of family members and clinicians along the lines of gender, race, clinical focus (patient diagnosis and physician subspecialty), and decisions at hand (Table 1).

When offered by clinicians during critical-care family conferences, spontaneous statements of good-parent praise were acknowledged by families, often with responses of praise for the clinical team, gratitude toward the clinical team, and expressions of reassurance of their parenting role. Good-parent praise statements have the potential to serve as powerful tools to help clinicians bond with families and support them during their children’s critical illness.

We thank the staff and family members at Children’s National Hospital for participating in this research.

Deidentified individual participant data will be made available on request.

Dr Porter conceptualized and designed the study, conducted data analysis and interpretation, and drafted the initial manuscript; Dr Hinds conceptualized and designed the study and contributed to data analysis and interpretation; Ms Livingston contributed to data analysis and interpretation; Dr October conceptualized and designed the study, collected the data, and contributed to data analysis and interpretation; and all authors reviewed and revised the manuscript and approved the final manuscript as submitted.

FUNDING: No external funding.

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.