The candidate's application provides the requisite training to establish a clinical research career committed to improving the health of families and children with critical illness, which is in line with the Pediatric Trauma and Critical Illness brach of NICHD. The candidate is a critical care and palliative medicine physician who is proposing to receive direct mentorship from a panel of experts and obtain training in quantitative and qualitative analyses, interventional study design and teaching communication skills. With this training plan she will develop and pilot an intervention that could very well improve communication between parents of children with critical illness and providers (physicians and nurse practitioners) who care for them. Health communication was added to the Healthy People 2010 objectives, recognizing that communication affects every aspect of health and disease. Effective communication between parents and providers is crucial during critical illness of children because inadequate communication can lead to delayed decisions and increased suffering for the child, conflict between the clinical team and parents, and parental distrust, dissatisfaction and psychosocial distress. Some of the major barriers to optimal communication in critical care are lack of provider communication skills training, time constraints, and provider discomfort with eliciting family values and preferences. In this 4-year study, we propose to develop and pilot an intervention which includes two components: (1) communication skills training for providers; and (2) use of a clinical measure, the Good Parent Tool (GPT) to elicit parental values and preferences around critical decision- making; then provide these individualized values to providers prior to a parent-provider conference and measure their use in the conference.
In Aim 1, we will develop the intervention by adapting a validated communication skills training program for critical care providers.
In Aim 2 we will assess the impact of the parental engagement intervention on provider's outcomes, while in Aim 3 we will assess the impact of the intervention on parent's outcomes. Parental engagement will be measured by audio-taped analysis using the Roter Interaction Analysis System. All other outcomes will be measured by surveys. We will use the data obtained from this study to generate effect sizes for future mixed methods communication multi-center intervention studies. This study constitutes a first step towards our long term research goal of understanding the impact of provider-directed communication interventions on parent outcomes.
Communication is key to every aspect of health and illness and particularly so in treatment decision making during critical illnesses. In childhood illnesses, health communication and care outcomes are optimized when parents are actively engaged in treatment discussions with their ill child's clinical team. We will create and test an intervention that is designed to positively and universally improve how healthcare providers in the pediatric intensive care unit communicate with parents by increasing parental engagement during treatment discussions.
