1
|
Crawford C, Arevalo Soriano T, Lu S, Rubenstein J, Jarrell JA. Evaluating a Pediatric Palliative Care Elective Rotation Through Prompted Reflective Writing and Aligning With Competencies. J Palliat Med 2024; 27:47-55. [PMID: 37594770 DOI: 10.1089/jpm.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background: Hospice and palliative medicine is important in the education of pediatric residents. Little is known about if and how residents' learnings during a pediatric palliative care elective fulfill core competencies and Pediatrics subcompetencies as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and published subspecialty competencies for residents in pediatric hospice and palliative medicine (pHPM). Objectives: To evaluate what residents are learning on a four-week pediatric palliative care elective rotation at a single institution and how these learnings fulfill ACGME and pHPM competencies. Setting/Subjects: Prompted, written reflections were collected from residents completing a pediatric palliative care rotation at a large, urban academic center in the United States between academic years 2016-2017 and 2020-2021. Measurements: A qualitative, inductive reasoning approach was used to analyze reflections for emergent themes and codes. A deductive approach was used to map resulting codes to ACGME core competencies, Pediatric subcompetencies, and pHPM competencies. Results: Twenty-five resident reflections were collected. Inductive analysis revealed three primary themes and 102 codes. These codes were mapped to all six ACGME core competencies and mapped to most Pediatric subcompetencies with the exception of performing a physical examination, organizing and prioritizing patients, diagnostic evaluation, and community and population health. Codes mapped to most pHPM competencies with the exception of two symptom-based competencies, malignant bowel obstruction and severe fatigue. Conclusions: Residents' written reflections following a pediatric palliative care elective rotation demonstrated robust learnings that fulfill many core, specialty, and subspecialty competencies, particularly those that relate to patient- and family-centered care, communication, professionalism, and systems-based practice.
Collapse
Affiliation(s)
- Claire Crawford
- Pediatric Advance Care Team (PACT), Texas Children's Hospital, Houston, Texas, USA
- Division of Palliative Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Shaoxin Lu
- PGY-3 Pediatrics Resident, Texas Children's Hospital, Houston, Texas, USA
| | - Jared Rubenstein
- Division of Palliative Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jill Ann Jarrell
- Division of Palliative Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
2
|
Scheurer JM, Norbie E, Bye JK, Villacis-Calderon D, Heith C, Woll A, Shu D, McManimon K, Kamrath H, Goloff N. Pediatric End-of-Life Care Skills Workshop: A Novel, Deliberate Practice Approach. Acad Pediatr 2022:S1876-2859(22)00566-6. [PMID: 36410600 DOI: 10.1016/j.acap.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric end of life (EOL) care skills are a high acuity, low occurrence skill set required by pediatric clinicians. Gaps in education and competence for this specialized care can lead to suboptimal patient care and clinician distress when caring for dying patients and their families. METHODS A half-day workshop using a deliberate practice approach was designed by an inter-professional workgroup including bereaved parent consultants. Pediatric fellows (neonatal-perinatal medicine, critical care, hematology oncology, blood and marrow transplant) and advanced practice providers learned and practiced EOL skills in a safe simulation environment with instruction from interprofessional facilitators and standardized patients. Participant perceived competence (self-efficacy) was measured before, immediately-post, and 3 months post workshop. RESULTS There were 28 first-time (of 34 total) participants in 4 pilot workshops. Participants reported significantly increased self-efficacy post-workshop for 6 of 9 ratings, which was sustained 3 months afterwards. Most (92%, n = 22 of 24 respondents) reported incorporating the workshop training into clinical practice at 3-month follow-up. CONCLUSIONS With early success of the pilot workshops, future iterative work includes expanding workshops to earlier, interprofessional learners and collecting validity evidence for a competency-based performance checklist tool. A project website (https://z.umn.edu/PECS) was developed for local and collaborative efforts.
Collapse
Affiliation(s)
- Johannah M Scheurer
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis
| | - Erik Norbie
- M Simulation (E Norbie and A Woll), University of Minnesota, Minneapolis
| | - Jeffrey K Bye
- Department of Educational Psychology and Research Methodology Consulting Center (JK Bye), University of Minnesota, Minneapolis
| | - Daniela Villacis-Calderon
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis
| | - Catherine Heith
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis
| | - Anne Woll
- M Simulation (E Norbie and A Woll), University of Minnesota, Minneapolis
| | - Dannell Shu
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis
| | - Kelly McManimon
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis
| | - Heidi Kamrath
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis; Children's Minnesota-Saint Paul (H Kamrath), Neonatology, Garden View Medical Center, Minn
| | - Naomi Goloff
- Department of Pediatrics (JM Scheurer, D Villacis-Calderon, C Heith, D Shu, K McManimon, H Kamrath, and N Goloff), University of Minnesota Medical School, Academic Office Building, Minneapolis.
| |
Collapse
|
3
|
Wraight CL, Eickhoff JC, McAdams RM. Gaps in Palliative Care Education among Neonatology Fellowship Trainees. Palliat Med Rep 2021; 2:212-217. [PMID: 34927144 PMCID: PMC8675219 DOI: 10.1089/pmr.2021.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: To provide proper care for infants at risk for death, neonatologists need expertise in many areas of palliative care. Although neonatology training programs have implemented a wide variety of palliative care educational programs, the impact of these programs on trainees' skills and effective communication regarding end-of-life issues remains unclear. Objective: To determine whether neonatology fellowship programs are providing formal palliative care education and assess whether this education is effective at increasing fellows' self-reported comfort with these important skills. Methods: An anonymous survey was sent to program directors (PDs) and fellows of ACGME accredited neonatology fellowship programs in the United States. Using a 5-point Likert scale, participants were asked about the palliative care education they received, and their comfort level with several key aspects of palliative care. Results: Twenty-four (26%) PDs and 66 (33%) fellows completed the survey. Fourteen PDs (58%) reported including palliative care education in their formal fellowship curriculum, whereas only 20 (30%) responding fellows reported receiving palliative care education. Of the responding fellows, most (80%) reported being uncomfortable or only somewhat comfortable with all assessed areas of palliative care. Fellows who received formal education were more comfortable than those without it in leading goals of care conversations (p = 0.001), breaking bad news (p = 0.048), discussing change in code status (p = 0.029), and grief and bereavement (p = 0.031). Conclusions: Most fellows report being uncomfortable or only somewhat comfortable with essential areas of palliative care. Formal palliative care education improves fellows' self-reported comfort with important aspects of end-of-life care. To promote a well-rounded neonatology fellowship curriculum, inclusion of formal palliative care education is recommended.
Collapse
Affiliation(s)
- Catherine Lydia Wraight
- Division of Neonatology, Department of Pediatrics, and University of Wisconsin, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - Ryan M McAdams
- Division of Neonatology, Department of Pediatrics, and University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|
4
|
Spiker M, Paulsen K, Mehta AK. Primary Palliative Care Education in U.S. Residencies and Fellowships: A Systematic Review of Program Leadership Perspectives. J Palliat Med 2020; 23:1392-1399. [DOI: 10.1089/jpm.2020.0331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Spiker
- Palliative Care, Department of Medicine, VA Greater Los Angeles, University of California, Los Angeles, Los Angeles, California, USA
| | - Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ambereen K. Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
| |
Collapse
|
5
|
Miller EG, Weaver MS, Ragsdale L, Hills T, Humphrey L, Williams CSP, Morvant A, Pitts B, Waldman E, Lotstein D, Linebarger J, Feudtner C, Klick JC. Lessons Learned: Identifying Items Felt To Be Critical to Leading a Pediatric Palliative Care Program in the Current Era of Program Development. J Palliat Med 2020; 24:40-45. [PMID: 32552386 DOI: 10.1089/jpm.2020.0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The experience of starting and growing a pediatric palliative care program (PPCP) has changed over the last 10 years as rapid increases of patient volume have amplified challenges related to staffing, funding, standards of practice, team resilience, moral injury, and burnout. These challenges have stretched new directors' leadership skills, yet, guidance in the literature on identifying and managing these challenges is limited. Methods: A convenience sample of 15 PPCP directors who assumed their duties within the last 10 years were first asked the following open-ended question: What do you wish you had known before starting or taking over leadership of a PPCP? Responses were grouped into themes based on similarity of content. Participants then ranked these themes based on importance, and an online discussion further elucidated the top ten themes. Results: Thirteen directors responded (86.7%; 69% female). The median age of their current-state PPCP was 5.1 years (range: 0.3-9.3), and the median number of covered pediatric-specific hospital beds was 283 (range: 170-630). Their responses generated 51 distinct items, grouped into 17 themes. Themes ranked as most important included "Learn how to manage, not just lead," "Negotiate everything before you sign anything," and "Balance patient volume with scope of practice." Conclusion: These themes regarding challenges and opportunities PPCP directors encountered in the current era of program growth can be used as a guide for program development, a self-assessment tool for program directors, a needs-assessment for program leadership, and a blueprint for educational offerings for PPCP directors.
Collapse
Affiliation(s)
- Elissa G Miller
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lindsay Ragsdale
- Division of Pediatric Palliative Care, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, USA
| | - Tracy Hills
- Section of Pediatric Palliative Care, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lisa Humphrey
- Division of Palliative Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program, Department of Pediatrics, Medical University of South Carolina Children's Health System, Charleston, South Carolina, USA
| | - Alexis Morvant
- Pediatric Palliative Care Program at Children's Hospital New Orleans, Division of Ambulatory Medicine, Department of Pediatrics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Blaine Pitts
- Division of Palliative Medicine, Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Elisha Waldman
- Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Debra Lotstein
- Division of Comfort and Palliative Care, Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Linebarger
- Section of Palliative Care, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Klick
- Department of Palliative Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Palliative Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
6
|
Kolmar A, Hueckel RM, Kamal A, Dickerman M. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Children in Neonatal and Pediatric Intensive Care Units. J Palliat Med 2019; 22:1149-1153. [DOI: 10.1089/jpm.2019.0378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amanda Kolmar
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina
| | - Rémi M. Hueckel
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina
| | - Arif Kamal
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
| | - Mindy Dickerman
- Division of Critical Care Medicine, Department of Pediatrics, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
- Division of Palliative Medicine, Department of Pediatrics, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| |
Collapse
|
7
|
Brock KE, Tracewski M, Allen KE, Klick J, Petrillo T, Hebbar KB. Simulation-Based Palliative Care Communication for Pediatric Critical Care Fellows. Am J Hosp Palliat Care 2019; 36:820-830. [PMID: 30974949 DOI: 10.1177/1049909119839983] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) education is lacking in pediatric critical care medicine (PCCM) fellowships, despite the desire of many program directors and fellows to expand difficult conversation training. Simulation-based training is an experiential method for practicing challenging communication skills such as breaking bad news, disclosing medical errors, navigating goals of care, and supporting medical decision-making. METHODS We describe a simulation-based PPC communication series for PCCM fellows, including presimulation session, simulation session, debriefing, and evaluation methods. From 2011 to 2017, 28 PCCM fellows participated in a biannual half-day simulation session. Each session included 3 scenarios (allowing for participation in up to 18 scenarios over 3 years). Standardized patients portrayed the child's mother. PCCM and interprofessional PPC faculty cofacilitated, evaluated, and debriefed the fellows after each scenario. Fellows were evaluated in 4 communication categories (general skills, breaking bad news, goals of care, and resuscitation) using a 3-point scale. A retrospective descriptive analysis was conducted. RESULTS One hundred sixteen evaluations were completed for 18 PCCM fellows. Median scores for general communication items, breaking bad news, and goals of care ranged from 2.0 to 3.0 (interquartile range [IQR]: 0-1) with scores for resuscitation lower at 1.0 (IQR: 1.5-2). DISCUSSION This experiential simulation-based PPC communication curriculum taught PCCM fellows valuable palliative communication techniques although revealed growth opportunities within more complex communication tasks. The preparation, methods, and lessons learned for an effective palliative simulation curriculum can be expanded upon by other pediatric training programs, and a more rigorous research program should be added to educational series.
Collapse
Affiliation(s)
- Katharine E Brock
- 1 Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.,2 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, GA, USA.,3 Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Meghan Tracewski
- 3 Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen E Allen
- 1 Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jeffrey Klick
- 3 Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Toni Petrillo
- 4 Division of Critical Care Medicine, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kiran B Hebbar
- 4 Division of Critical Care Medicine, Department of Pediatrics, Emory University, Atlanta, GA, USA
| |
Collapse
|
8
|
Geerse OP, Lakin JR, Berendsen AJ, Alfano CM, Nekhlyudov L. Cancer survivorship and palliative care: Shared progress, challenges, and opportunities. Cancer 2018; 124:4435-4441. [DOI: 10.1002/cncr.31723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Olaf P. Geerse
- Department of Pulmonary Diseases University Medical Center Groningen, University of Groningen Groningen the Netherlands
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
| | - Joshua R. Lakin
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts
| | - Annette J. Berendsen
- Department of General Practice and Elderly Medicine University Medical Center Groningen, University of Groningen Groningen the Netherlands
| | | | - Larissa Nekhlyudov
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
| |
Collapse
|
9
|
Wilson PM, Herbst LA, Gonzalez-del-Rey J. Development and Implementation of an End-of-Life Curriculum for Pediatric Residents. Am J Hosp Palliat Care 2018; 35:1439-1445. [DOI: 10.1177/1049909118786870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Caring for a child near the end of life (EOL) can be a stressful experience. Resident physicians are often the frontline providers responsible for managing symptoms, communicating difficult information, and pronouncing death, yet they often receive minimal education on EOL care. Objective: To develop and implement an EOL curriculum and to study its impact on resident comfort and attitudes surrounding EOL care. Design: Kern’s 6-step approach to curriculum development was used as a framework for curriculum design and implementation. Setting/Participants: Categorical and combined pediatric residents at a large quaternary care children’s hospital were exposed to the curriculum. Measurements: A cross-sectional survey was distributed pre- and postimplementation of the curriculum to evaluate its impact on resident comfort and attitudes surrounding EOL care. Results: One-hundred twenty-six (49%) of 258 residents completed the preimplementation survey, and 65 (32%) of 201 residents completed the postimplementation survey. Over 80% of residents reported caring for a dying patient, yet less than half the residents reported receiving prior education on EOL care. Following curriculum implementation, the percentage of residents dissatisfied with their EOL education fell from 36% to 14%, while the percentage of residents satisfied with their education increased from 14% to 29%. The postimplementation survey identified that resident comfort with communication-based topics improved, and they sought additional training in symptom management. Conclusions: The implementation of a longitudinal targeted multimodal EOL curriculum improved resident satisfaction with EOL education and highlighted the need for additional EOL education.
Collapse
Affiliation(s)
- Paria M. Wilson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lori A. Herbst
- Division of Hospital Medicine, Department of Pediatrics and General Internal Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Javier Gonzalez-del-Rey
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
10
|
Rossfeld ZM, Tumin D, Humphrey LM. Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation. J Palliat Med 2018; 21:229-235. [DOI: 10.1089/jpm.2017.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Zachary M. Rossfeld
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Lisa M. Humphrey
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
11
|
Abstract
OBJECTIVE Neonatal ICUs and PICUs increasingly admit patients with chronic critical illness: children whose medical complexity leads to recurrent and prolonged ICU hospitalizations. We interviewed participants who routinely care for children with chronic critical illness to describe their experiences with ICU care for pediatric chronic critical illness. DESIGN Semi-structured interviews. Interviews were transcribed and analyzed for themes. SETTING Stakeholders came from five regions (Seattle, WA; Houston, TX; Jackson, MS; Baltimore, MD; and Philadelphia, PA). SUBJECTS Fifty-one stakeholders including: 1) interdisciplinary providers (inpatient, outpatient, home care, foster care) with extensive chronic critical illness experience; or 2) parents of children with chronic critical illness. INTERVENTIONS Telephone or in-person interviews. MEASUREMENTS AND MAIN RESULTS Stakeholders identified several key issues and several themes emerged after qualitative analysis. Issues around chronic critical illness patient factors noted that patients are often relocated to the ICU because of their medical needs. During extended ICU stays, these children require longitudinal relationships and developmental stimulation that outstrip ICU capabilities. Family factors can affect care as prolonged ICU experience leads some to disengage from decision-making. Clinician factors noted that parents of children with chronic critical illness are often experts about their child's disease, shifting the typical ICU clinician-parent relationship. Comprehensive care for children with chronic critical illness can become secondary to needs of acutely ill patients. Lastly, with regard to system factors, stakeholders agreed that achieving consistent ICU care goals is difficult for chronic critical illness patients. CONCLUSIONS ICU care is poorly adapted to pediatric chronic critical illness. Patient, family, clinician, and system factors highlight opportunities for targeted interventions toward improvement in care.
Collapse
|