The National Palliative Care Research Center

Curing suffering through palliative care research.


Monica Lemmon, MD

Assistant Professor

Duke University

Grant Year
Grant Term
Grant Type
Junior Faculty Career Development

Project Description
No question too Small: Development of a Question Prompt List for Infants and their Families

Despite major advances in neonatal care, many infants in the neonatal intensive care unit (NICU) die or survive with profound neurodevelopmental disability. Data from parents show that good communication with clinicians is critical as they consider how to make decisions for their infants. Our overall goal is to improve communication between parents and clinicians by adapting a tool that has been successful in other disciplines – a Question Prompt List (QPL) – for use in the NICU. The QPL is an emerging communication strategy that guides patients’ interactions with their healthcare team by providing patients with suggested questions to ask their clinicians, which can be reviewed by clinicians prior to high-stakes clinical encounters. QPLs promote self-efficacy by validating patient concerns and providing prompts for initiating and participating in difficult conversations. We will develop and study a QPL tailored to the needs of families of infants at risk of brain injury.

In specific aim 1, we will use qualitative analysis to derive question content from two sources of existing data: 1) audio-recorded NICU family meetings and 2) interviews with parents of infants with brain injury. In specific aim 2, we will refine QPL content using parent focus groups, clinician focus groups, and formative cognitive testing.   In specific aim 3, we will pilot the QPL. Families will be given the QPL in advance of a planned family conference. They will be asked to identify high priority questions which will be shared with their clinician in advance of the conference. Conferences will be audio-recorded for analysis. The primary outcome of the pilot will be feasibility; however, we will use this opportunity to examine exploratory measures for future study planning. The results will directly inform the implementation and study of the QPL for NICU families in a multicenter trial.


Monica Lemmon, MD is an Assistant Professor of Pediatrics at Duke University Hospital within the division of child neurology. Dr. Lemmon works as a fetal and neonatal neurologist and cares for infants with neurologic disease. She is a past recipient of the American Academy of Neurology’s medical education research training fellowship, and has worked to measure and improve medical student training in communication skills. Her current research focuses on understanding and improving how parents and clinicians work together to make decisions for critically ill infants.