Improving family outcomes with a communication intervention in the pediatric ICU. This project will evaluate the effects of integrating a standardized interdisciplinary communication intervention into the pediatric intensive care unit (PICU). The proposed intervention is designed to support families when their child is in the PICU for 7 days or more and to reduce the stress associated with the experience. Intervention group families will receive up to 3 weekly care conferences beginning on day 7 of the PICU stay that will be facilitated by members of the interdisciplinary pediatric palliative care team and at least 3 follow-up visits per week by the same facilitator to keep families informed about their child's health status and offer emotional support and informational resources. Control group families will receive usual care in the PICU. Outcomes will be assessed at discharge from the PICU and 90 days after study enrollment. The project will use a cluster-randomized control trial design and quantitative and qualitative methods to evaluate (1) the efficacy of the communication intervention on reducing family symptoms of post-traumatic stress disorder 3 months after study enrollment and acute stress disorder at the time the child is discharged from the PICU;(2) the effect of the intervention on increasing family satisfaction with clinician communication and reducing family perceptions of conflict;(3) the efficacy of the intervention on reducing PICU length of stay and resource utilization without affecting mortality rates;and (4) the ICU experience for families in the intervention and control groups and clinicians, and barriers and facilitators to implementing the intervention.

Public Health Relevance

The pediatric intensive care unit (PICU) is an emotionally-charged atmosphere that places significant demands on patients and families and can induce symptoms of acute stress and post-traumatic stress disorder amongst parents. Reducing stress in families of critically ill children is very important as they must maintain a reserve of resources to manage whatever demands will follow after their child transitions to home or dies in the hospital. The study intervention is designed to provide families with additional psychosocial resources (i.e., open communication with the clinical team, and instrumental and emotional support) to reduce the stress of the PICU and extends successful research done in adult ICUs to pediatric settings.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR011179-02
Application #
7941863
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Huss, Karen
Project Start
2009-09-29
Project End
2014-06-30
Budget Start
2010-07-13
Budget End
2011-06-30
Support Year
2
Fiscal Year
2010
Total Cost
$592,060
Indirect Cost
Name
Seattle Children's Hospital
Department
Type
DUNS #
048682157
City
Seattle
State
WA
Country
United States
Zip Code
98105
Richards, Claire A; Starks, Helene; O'Connor, M Rebecca et al. (2018) Physicians Perceptions of Shared Decision-Making in Neonatal and Pediatric Critical Care. Am J Hosp Palliat Care 35:669-676
Coats, Heather; Bourget, Erica; Starks, Helene et al. (2018) Nurses' Reflections on Benefits and Challenges of Implementing Family-Centered Care in Pediatric Intensive Care Units. Am J Crit Care 27:52-58
Richards, Claire A; Starks, Helene; O'Connor, M Rebecca et al. (2018) When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? Am J Hosp Palliat Care 35:840-846
Richards, Claire A; Starks, Helene; O'Connor, M Rebecca et al. (2017) Elements of Family-Centered Care in the Pediatric Intensive Care Unit: An Integrative Review. J Hosp Palliat Nurs 19:238-246
Starks, Helene; Doorenbos, Ardith; Lindhorst, Taryn et al. (2016) The Family Communication Study: A randomized trial of prospective pediatric palliative care consultation, study methodology and perceptions of participation burden. Contemp Clin Trials 49:15-20
Doorenbos, Ardith Z; Starks, Helene; Bourget, Erica et al. (2013) Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. J Palliat Med 16:492-5
Doorenbos, Ardith; Lindhorst, Taryn; Starks, Helene et al. (2012) Palliative care in the pediatric ICU: challenges and opportunities for family-centered practice. J Soc Work End Life Palliat Care 8:297-315