The Use of Family Conferences in the Pediatric Intensive Care Unit (original) (raw)
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Pediatric Critical Care Medicine, 2011
Objective-To examine clinicians' and parents' reflections on pediatric intensive care unit (PICU) family conferences (FCs) in the context of discussion about end-of-life care decision making. Design-Retrospective qualitative study Setting-A university-based hospital Participants-Eighteen parents of children who died in the PICU and 48 PICU clinicians (physicians, nurses, social workers, child-life specialists, chaplains, and case managers). Interventions-In depth, semi-structured focus groups and one-on-one interviews designed to explore experiences in end-of-life care decision making. Measurements and Main Results-We identified comments about FCs in all clinician focus groups/interviews, except one individual nurse interview, and in 13 of the 18 parent interviews. Comments from parents were sparse compared to those from clinicians. Four topics emerged: purpose, structural aspects, challenges, and suggestions for improvement. We identified three purposes for FCs: communication between clinicians and parents; communication among clinicians; and support of families. Described structural aspects of FCs included: pre-conference planning, communication during conferences, and post-conference processing. Challenges noted involved communicating with parents during FCs such as: difficulties associated with having
Health Communication, 2016
While there is a robust literature describing family conferences (FCs) in adult intensive care units (ICUs), less information exists about FCs in pediatric ICUs (PICUs). We conducted a pilot study to describe the focus of discussion, communication patterns of health care team members (HTMs) and parents, and parents' perspectives about clinician communication during PICU FCs. We analyzed data from 22 videoor audiorecorded PICU FCs and post-FC questionnaire responses from 27 parents involved in 18 FCs. We used the Roter Interaction Analysis System (RIAS) to describe FC dialogue content. Our questionnaire included the validated Communication Assessment Tool (CAT). FCs were focused on care planning (n = 5), decision making (n = 6), and updates (n = 11). Most speech came from HTMs (mean 85%; range, 65-94%). Most HTM utterances involved medical information. Most parent utterances involved asking for explanations. The mean overall CAT score was 4.62 (using a 1-5 scale where 5 represents excellent and 1 poor) with a mean of 73.02% "excellent" responses. Update and care-planning FCs had lower CAT scores compared to decision-making FCs. The lowest scoring CAT items were "Involved me in decisions as much as I wanted," "Talked in terms I could understand," and "Gave me as much information as I wanted." These findings suggest that while health care providers spend most of their time during FCs relaying medical information, more attention should be directed at providing information in an understandable manner. More work is needed to improve communication when decision making is not the main focus of the FC. Clinicians use family conferences (FCs) to communicate with families of patients and other health care team members (HTMs). Research in adult intensive care units (ICUs) shows that during FCs clinicians may deliver bad news and discuss medical decisions, including end-of-life considerations (
Journal of Palliative Medicine, 2020
Background: Communication between clinicians and families of dying children in the pediatric intensive care unit (PICU) is critically important for optimal care of the child and the family. Objective: We examined the current state of clinician perspective on communication with families of dying children in the PICU. Design: Prospective case series over a 15-month study period. Setting/Subjects: We surveyed nurses, psychosocial staff, and physicians who cared for dying children in PICUs at five U.S. academic hospitals. Measurements: Clinicians reported on the location of communication, perceived barriers to end-of-life care, and rated the quality of communication (QOC). Results: We collected 565 surveys from 287 clinicians who cared for 169 dying children. Clinicians reported that the majority of communication occurred at the bedside, and less commonly family conferences and rounds. Ten barriers to care were examined and were reported with frequencies of 2%-32%. QOC was rated higher when the majority of conversations occurred during family conferences (p = 0.01) and lower for patients of nonwhite race (p = 0.03). QOC decreased when 8 of the 10 barriers to care were reported. Conclusions: When a child is dying, clinicians report that communication with the family occurs most frequently at the child's bedside. This has important implications for future ICU communication research as the majority of previous research and education has focused on family care conferences. In addition, findings that QOC is perceived as lower for non-white patients and when clinicians perceive that barriers hindering care are present can help direct future efforts to improve communication in the PICU.
Parent talk at intensive care unit rounds
Social Science & Medicine. Part E: Medical Psychology, 1981
We analyzed verbatim transcriptions of audiotaped rounds in a large pediatric intensive care unit to determine how physicians refer to families of critically ill children. In almost 4 hours of rounds recorded on 3 days in I week. the doctors mentioned the families of 11 of the 25 different patients discussed. There were I9 discreet references to parents or an average of 1 reference every 12; minutes, Nine references were made during the formal presentation of the patients' medical histories. Three references to parents involved discharge of chronically ill children. The 7 remaining references were about the families of 3 children with grim prognoses. Parental references which occurred in presentations and discharge plans had a ceremonial character. Other references to families were infrequent and only occurred when physicians believed medical measures were no longer efficacious. We conclude that doctors do not consider family matters in the systematic way they discuss technical concerns.
Communication & Medicine, 2010
Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents' hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians' management of prognostic uncertainty and parents' struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating 'I was part of -I really was part of the team.' (44) 'The family's down there struggling and trying and working just as hard as anybody else.' 1 This work was supported by cooperative agreements from the National Institute of Child Health and Human Development and the Department of Health and Human Services. Full details of this study, including a description of the ethical protocols for working with bereaved parents, were provided to the reviewers of this article and are published in and . The original study found that the majority of parents (n = 33/56, 59%) would like to have a family conference regarding their child's death, partly to review information about the course of their child's care and death in the PICU and gain reassurance that their child had received the best care possible, but also to provide feedback about the experience ). In a second study, Meert et al.
Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians
Palliative medicine, 2016
Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions. Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents. We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis. We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender. The decisions about medical indication were based on considerations relati...