Dr. Meyer's clinical work and scholarship as a nurse-psychologist have been centered in neonatal and pediatric critical care, with particular focus on parental perspectives, pediatric end-of-life care, communication and relational skills, and humanism in health care. The foundation that unites her research has been to better understand the priorities of families through their eyes and to meet these needs with innovative interprofessional education and clinical practice change. Given how vital communication is to families, Dr. Meyer's research has focused on innovative simulation-based education to enable clinicians hold difficult healthcare conversations across a wide range of clinical practice settings and topics, including conveying serious diagnoses, informed consent, parent presence during invasive procedures and resuscitation, organ donation, and adverse medical outcomes. Her program of clinical research has blended quantitative and qualitative approaches.
1. Meyer EC, Ritholz MD, Burns JP, Truog RD. Improving the quality of end-of-life care in the pediatric intensive care unit: Parents’ priorities and recommendations. Pediatrics 2006; 117(3):649-657.
This widely cited publication reports the findings of a qualitative study that documents parents’ priorities and recommendations for end-of-life care in the pediatric intensive care unit. Parents identified six priorities including honest and complete information, ready access to staff, communication and care coordination, emotional expression and support by staff, preservation of the integrity of the parent-child relationship, and faith. The article was among the first to present actual quotations from family members whose children had died, to bring parents’ voices and perspectives to bear when conceptualizing quality of care standards, and to delineate parent-generated clinical implications. As such, the work has influenced the quality and delivery of end-of-life care in pediatric critical care setting. The work also served as the impetus for my decision to devote a good part of my career to educating interprofessional clinicians to feel more capable and confident when holding necessary, challenging healthcare conversations with families.
2. Waisel D, Lamiani G, Sandrock N, Pascucci, R, Truog RD, Meyer EC. Anesthesiology trainees face ethical, practical and relational challenges in obtaining informed consent. Anesthesiology 2009; 110:480-486.
This publication documented the substantial communication and relational challenges that confront anesthesiology trainees when obtaining informed consent. Ethical challenges were the most distressing to trainees, including situations when mentally competent patients were pressured to proceed with surgery against their better judgment or when patient wishes ran counter to medical advice. Practical challenges included language barriers, pain management and level of consciousness, and time pressures. Relational challenges included previous negative health care experiences, mistrust, and devaluing of trainees’ capabilities because of youth and training status. The article established the rationale and curricular groundwork necessary to develop the successful Program to Enhance Relational and Communication Skills (PERCS)-Anesthesia course offered at Harvard Medical School affiliate hospitals. The article was selected as the Anesthesiology Editor’s top ten articles of the year and has received widespread attention.
3. Meyer EC, Brodsky D, Hansen AR, Lamiani G, Sellers DE, Browning DM. An interdisciplinary, family-focused approach to relational learning in neonatal intensive care. Journal of Perinatology 2011; 31(3):212-219.
This publication is one in a series that established the efficacy, replicability, and cross-cultural applicability of the Program to Enhance Communication and Relational Skills (PERCS) educational paradigm; and has contributed substantially to the field regarding interprofessional learning and teamwork. The simulation-based educational paradigm utilizes professional actors and realistic case enactments, and is widely applicable across a range of challenging health care conversations such as conveying serious diagnoses, informed consent, organ donation, and adverse medical outcomes. Interprofessional PERCS participants reported enduring improvements in their sense of preparation to hold difficult conversations, more confidence, enhanced communication and relational skills, and decreased anxiety. Moreover, 5-12 months post-educational intervention, over 90% of participants reported drawing on their learning and three-quarters made substantive clinical practice changes as a result of the workshops.
4. Curley MAQ, Meyer EC, Scoppettuolo, McGann EA, Trainor BP, Rachwal C, Hickey PA. Parent presence during invasive procedures and resuscitation: Evaluating a clinical practice change. American Journal of Respiratory and Critical Care Medicine 2012; 186(11):1133-1139.
This large multiphase pre-post survey study, conducted over four years, examined the impact of practice guidelines and interprofessional education on clinician perceptions and practice of parent presence during invasive procedures/resuscitation. I oversaw the development and implementation of the simulation-based educational intervention for the study. Following the intervention, clinicians reported that parents were present during more invasive procedures and reported higher levels of preparedness and comfort with providing options to parents during resuscitative events. Levels of comfort were higher among clinicians who had practiced skills in the simulated environment, thus supporting the efficacy of innovative simulation education. Importantly, parents who reported having information to help them prepare for their children’s procedures experienced higher levels of procedural understanding and emotional support. The study also reported the degree of interference of parent presence during technical procedures (4%), therapeutic decision-making (5%) and ability to teach (9%). A companion educational film has been produced and distributed widely, further enhancing the impact of the work to effect clinical practice change. The film won the Silver Remi Award at the Worldfest-Houston International Film Festival.
5. Lamiani G, Barello S, Browning DM, Vegni E, Meyer EC. Uncovering and validating clinicians’ experiential knowledge when facing difficult conversations: A cross-cultural perspective. Patient Education and Counseling 2012; 87:307-312.
Healthcare communication training approaches typically under recognize and under value clinicians’ experiential, already-existing relational knowledge. This publication, conducted cross-culturally in Program to Enhance Relational and Communication Skills (PERCS) workshops in United States and Italy, reported the strategies that clinicians had found helpful when holding difficult healthcare conversations. Strategies that were similar across both countries were related to organizational aspects and setting preparation, communication and relational skillfulness, clinician mindfulness, interpersonal qualities and sensibilities, and teamwork and care coordination. American clinicians also cited attentiveness to cultural differences as important. The work has significant pedagogical implications, advocating that communication skills faculty and educational programs can best foster clinicians’ sense of preparation and confidence by recognizing and building upon their already-existing knowledge.
6. Tunick RA, Gavin JA, DeMaso DR, Meyer EC. Pediatric psychology critical care consultation: An emerging subspecialty. Clinical Practice in Pediatric Psychology 2013; 1(1):42-54.
Based on data from consecutive admissions over a three-year period, this hallmark study provided a much-needed analysis of the mental health needs and pediatric psychology referral patterns for children requiring pediatric intensive care hospitalization and their families. Children who required longer hospitalizations, had unanticipated emergency admissions, were previously healthy prior to admission, and who were approaching end of life circumstances were most likely to be referred for psychology services. The findings have meaningful wide-ranging implications for the growing field of critical care pediatric psychology relative to case finding, viable consultation models, optimized service delivery, and professional training.
7. Brown SD, Callahan MJ, Browning DM, Lebowitz RL, Bell SK, Jang J, Meyer EC. Radiology trainees’ comfort with difficult conversations and attitudes about error disclosure: Effect of a communication skills workshop. Journal of the American College of Radiology 2014; 11:781-787.
This article successfully demonstrated the applicability and effectiveness of simulation-based communication training for the field of radiology and was the winner of the Journal of the American College of Radiology Best Education Article of the Year, $1000 prize. The educational intervention improved radiologists’ sense of confidence and ability to convey serious diagnostic findings, discern and disclose medical error, and discuss radiologic safety and risk. As a result of the Program to Enhance Communication and Relational Skills (PERCS) workshops, radiologists were also more willing to apologize and disclose during the aftermath of medical errors. As a result of the work, my radiologic colleagues and I have been invited to present pre-conference educational workshops at the annual national convention of the American College of Radiology. The educational intervention has also been featured and recommended in the national organization’s print and on-line public relations outreach.
8. Bell SK, Pascucci RC, Fancy KM, Coleman K, Zurakowski D, Meyer EC. The educational value of improvisational actors to teach communication and relational skills: Perspectives of interprofessional learners, faculty, and actors. Patient Education and Counseling 2014; 96:381-388.
This work examined the broad educational value of improvisational actors as integral to simulation-based communication training and helped to position me as a thought leader in the field of simulation. For the simulation world, the article tackled salient questions of whether actors are educationally superior to role-playing with colleagues and worth the additional expense and effort. Findings suggest that, yes, particularly for training around sensitive topics and ethically challenging issues, actors bring significant value added to communication training. The work concluded that improvisational actors can offer unmatched realism, depth of emotion, practice opportunities and formative feedback that can change clinicians’ attitudes and approach to communication and, subsequently, influence the quality of care.
9. Martin EB, Mazzola NM, Brandano J, Luff D, Zurakowski D, Meyer EC. Clinicians' recognition and management of emotions during difficult healthcare conversations. Journal of Patient Education and Counseling 2015; 98(10):1248-1254.
This article represents the first in a series that addresses how to help interprofessional clinicians better recognize and attend to their own emotions during stressful encounters, in the service of better communication and relationships with patients and families. The article represents an innovative shift in the patient-provider communication field and, as such, was recognized as among the best abstracts at the American Academy of Communication in Healthcare Conference and invited for publication in the Journal of Patient Education and Counseling. Our findings identified the most common emotions experienced by clinicians as anxiety, sadness, empathy, frustration and insecurity- and documented how these emotions can influence the patient-provider relationship in myriad ways. Helping clinicians to cultivate self-awareness and better emotional regulation can promote whole providers steadied to treat whole patients and their families.
10. Robinson M, Thiel MM, Zurakowski D, Shirkey K, Meyer EC. Efficacy of training interprofessional spiritual case generalists. Journal of Palliative Medicine 2016; 19(8):814-821.
Some of the most challenging healthcare conversations revolve around spiritual, religious and existential issues important to families, for which there has been a paucity of professional learning opportunities. This work was prompted by clinical experiences in the pediatric intensive care unit when families would ask, “What kind of a God would allow my child to suffer?” or “Would you pray with us?’ This article reported on the successful adaptation and efficacy of the Program to Enhance Relational and Communication Skills (PERCS) educational paradigm to enable clinicians to practice and provide capable, confident and ethical generalist-level spiritual screening and care. The innovative educational approach and success of the program was featured as article of the month by the national Association for Clinical Pastoral Education. Future adaptation of the educational model to any number of challenging healthcare conversations is promising- and wide open to imagination and opportunities.
11. Carter BS, Brown JB, Brown S, and Meyer EC. Four Wishes for Aubrey. Journal of Perinatology 2012; 32, 10–1.
In the critical care environment, what begins as cure-oriented and life- extending treatment may become unsuccessful in overcoming the patient’s increasingly complex pathophysiology. A case from the neonatal intensive care unit is presented and used to elaborate upon care transitions toward palliative and supportive care that can be rendered in the hospital, at home or in a hospice facility. Successful transitions may rest upon anticipatory guidance by the primary physician and team, or a consultant, to facilitate and enable parents and team members alike in addressing the hard realities that cure, or even successful ICU discharge, is unlikely. A simple mechanism of addressing and accommodating a family’s wishes is provided.
12. Meyer EC. Courage, Brains and Heart: Lessons from the Wizard of Oz for difficult healthcare conversations. Australian Critical Care 2012.
Despite proficiency in technical skills and subspecialty practice, healthcare providers can feel poorly prepared and ill-equipped to hold vital though challenging conversations in healthcare. This article describes the useful Wizard of OZ metaphor and approach to challenging conversations in healthcare. Conjuring the Lion, Scarecrow and Tin Man, the reader is reminded of the important ingredients for successful conversations- courage, brains and heart. The article emphasizes the need for balance amongst the three ingredients and provides several illustrations of communication and relational skills that are generalizable to a range of healthcare situations.
13. Browning DM, Meyer EC, Truog RD, Solomon MZ. Difficult conversations in health care: Cultivating relational learning to address the hidden curriculum. Academic Medicine 2007; 82(9):905-913.
In this article the pedagogy of the Program to Enhance Relational and Communication Skills (PERCS) are reviewed and described. Central to the learning are patient and family perspectives of the illness experience, interprofessional learning in which traditional medical hierarchy is eased, and incorporating the ethics of everyday clinical encounters. Realistic enactments with professional actors are featured in the workshops where clinicians have the opportunity to practice as teams and receive thoughtful feedback about their communication and relational skills from the actors, family faculty, and fellow learners. The actors are conceptualized as "ethical understudies" for patients and family members to deepen the learners' appreciation and approaches to ethical issues.
14. Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD. Difficult conversations: Improving communication skills and relational abilities in health care. Pediatric Critical Care Medicine 2009; 10(3):352-359.
This article describes and documents the efficacy of the Program to Enhance Relational and Communication (PERCS) simulation-based one-day workshops. Interprofessional learners who participated in the workshops reported greater preparation, confidence, communication skills and relationship-building capacity when holding difficult healthcare conversations, as well as less anxiety. The workshops resulted in significant learning regardless of discipline and years of experience. Those learners who had the lowest baseline appraisals of their communication skills made the greatest improvements.
To access Dr. Meyer's peer-reviewed publications, please visit: https://www.ncbi.nlm.nih.gov/sites/myncbi/1nKa6JF9VEOQa/collections/52578974/public/