Prognostic conversations between parents and physicians in the pediatric intensive care unit

Authors

Lauren Rissman, Advocate Aurora HealthFollow
Sabrina Derrington, Sabrina Derrington is a pediatric critical care physician and bioethicist in the Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, California, and in the Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles.
Kelly N. Michelson, Kelly N. Michelson is a pediatric critical care physician and bioethicist in the Division of Pediatric Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois, and in the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago.

Recommended Citation

Rissman L, Derrington S, Michelson KN. Prognostic Conversations Between Parents and Physicians in the Pediatric Intensive Care Unit. Am J Crit Care. 2023;32(2):118-126. doi:10.4037/ajcc2023729

Affiliations

Advocate Children's Hospital

Abstract

Background: Up to 80% of pediatric intensive care unit (PICU) patients experience new morbidities upon discharge. Patients and families rely on clear communication to prepare for post-PICU morbidities.

Methods: Surveys were given at PICU discharge to parents and attending physicians of patients who developed multi-organ dysfunction within 24 hours of PICU admission and whose parents completed an initial survey 5 to 10 days after PICU admission. Participants were asked about prognostic conversations regarding PICU mortality; patient post-PICU physical, cognitive, and psychological morbidities; and parent post-PICU psychological morbidities. Parents also indicated whether they wanted more prognostic information.

Results: Forty-nine parents and 20 PICU attending physicians completed surveys for 49 patients. Thirty parent (61%) and 29 physician (59%) surveys reported participating in any prognostic conversations. Concordance between parents and physicians about prognostic conversations was slight (κ = 0.19). Parent (n = 22; 45%) and physician (n = 23; 47%) surveys most commonly reported prognostic conversations about post-PICU physical morbidities. Parents less commonly reported conversations about post-PICU cognitive morbidities (n = 10; 20%). According to parents, bedside nurses and physicians provided most prognostic information; social workers (54%) most commonly discussed parent psychological morbidities. Twenty-six parents (53%) requested more prognostic information.

Conclusions: Most parents and physicians reported having prognostic conversations, primarily about post-PICU physical morbidities. More than half of parents wanted more information about potential post-PICU morbidities. More research is needed to understand how and when medical professionals should have prognostic conversations with parents.

Document Type

Article

PubMed ID

36854914