Research In Practice Blog
Intro
For parents of children in the cardiac intensive care unit (CICU), family meetings (FM) provide an opportunity for clinical updates, emotional support, and shared decision-making. But evidence is scant about how to optimize FM preparation and communications for both clinicians and parents. Parents often report feeling anxious and unprepared for FM, and clinician approaches are not standardized. A pediatric research team set out to investigate the outcomes of the co-designed intervention CICU Teams And Loved Ones Communicating (CICU TALC).
Study design & findings
A pre- and post-test pilot intervention study was conducted to (1) evaluate enrollment and data-collection feasibility, (2) evaluate post-training intervention protocol adherence by clinicians, (3) evaluate parents’ perceptions of the intervention, and (4) determine impact on clinician FM-related communication behaviors. The intervention involved 60 patient-parent pairs and consisted of clinician- and parent-facing elements.
For clinicians, FM communication training and procedures were implemented, and new documentation practices were introduced. Adherence to intervention protocols was measured, as were FM behaviors. The intervention yielded a rise in engagement-focused communications with families and an increase in empathetic statements.
For parents, a pre-FM preparatory worksheet eliciting concerns and communication preferences and a post-FM summary were implemented. Parent participation and engagement was measured, and feedback was collected through surveys and semi-structured interviews. The intervention materials were found to reduce parental anxiety and increase feelings of preparedness and organization.
Implications
The CICU TALC intervention demonstrated the feasibility of implementing interprofessional team training, adherence to the intervention protocol, and the parental perception of acceptability of this approach. Moreover, these clinician- and patient-facing protocols, when used together, showed potential to improve FM and clinician/patient communication. Thus, health systems seeking to strengthen their family-centered care approaches might consider replicating this intervention model.
Additonal information:
- Continuity Strategies for Long-Stay PICU Patients: Consensus Statements From the Lucile Packard Foundation PICU Continuity Panel.
Edwards JD, Wocial LD, Madrigal VN, Moon MM, Ramey-Hunt C, Walter JK, Baird JD, Leland BD.
Pediatr Crit Care Med. 2023 Oct 1;24(10):849-861. doi: 10.1097/PCC.0000000000003308. Epub 2023 Oct 3.
PMID: 38415714 Free PMC article. Review. - Intervention Codesign in the Pediatric Cardiac Intensive Care Unit to Improve Family Meetings.
Walter JK, Hill D, Drust WA, Lisanti A, DeWitt A, Seelhorst A, Hasiuk ML, Arnold R, Feudtner C.
J Pain Symptom Manage. 2022 Jul;64(1):8-16. doi: 10.1016/j.jpainsymman.2022.03.010. Epub 2022 Mar 23.
PMID: 35339610 Free PMC article. - Parental communication satisfaction with the clinical team in the pediatric cardiac ICU.
Walter JK, Feudtner C, Cetin A, DeWitt AG, Zhou M, Montoya-Williams D, Olsen R, Griffis H, Williams C, Costarino A.
Cardiol Young. 2024 Feb;34(2):282-290. doi: 10.1017/S1047951123001555. Epub 2023 Jun 26.
PMID: 37357911 - Parent communication with care teams and preparation for family meetings in the paediatric cardiac ICU: a qualitative study.
Gramszlo C, Girgis H, Hill D, Walter JK.
Cardiol Young. 2024 Jan;34(1):113-119. doi: 10.1017/S1047951123001282. Epub 2023 May 25.
PMID: 37226505
Clinical Futures author(s):
Jennifer Walter, MD, PhD, MS; Douglas L Hill, PhD, Arzu Cetin, MS; Karen Puopolo, MD, PhD; Chris Feudtner, MD, PhD, MPH
Additional study author(s) from Children’s Hospital of Philadelphia:
Aaron DeWitt, MD; Katie Kellom; William Quarshie, MS; Heather Griffis, PhD; Justine Shults, PhD, MS; Martha A Q Curley, PhD, RN