Walter Jennifer, Hill Douglas L, Cetin Arzu, DeWitt Aaron, Kellom Katie, Quarshie William, Griffis Heather, Shults Justine, Arnold Robert, Tjia Jennifer, Puopolo Karen, Curley Martha A Q, Feudtner Chris
Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Cardiol. 2025 Apr;46(4):785-797. doi: 10.1007/s00246-024-03497-7. Epub 2024 May 3.
Parents of children in the pediatric cardiac intensive care unit (CICU) are often unprepared for family meetings (FM). Clinicians often do not follow best practices for communicating with families, adding to distress. An interprofessional team intervention for FM is feasible, acceptable, and positively impacts family preparation and conduct of FM in the CICU. We implemented a family- and team-support intervention for conducting FM and conducted a pretest-posttest study with parents of patients selected for a FM and clinicians. We measured feasibility, fidelity to intervention protocol, and parent acceptability via questionnaire and semi-structured interviews. Clinician behavior in meetings was assessed through semantic content analyses of meeting transcripts tracking elicitation of parental concerns, questions asked of parents, and responses to parental empathic opportunities. Logistic and ordinal logistic regression assessed intervention impact on clinician communication behaviors in meetings comparing pre- and post-intervention data. Sixty parents (95% of approached) were enrolled, with collection of 97% FM and 98% questionnaire data. We accomplished > 85% fidelity to intervention protocol. Most parents (80%) said the preparation worksheet had the right amount of information and felt positive about families receiving this worksheet. Clinicians were more likely to elicit parental concerns (adjusted odds ratio = 3.42; 95%CI [1.13, 11.0]) in post-intervention FM. There were no significant differences in remaining measures. Implementing an interprofessional team intervention to improve family preparation and conduct of FM is locally feasible, acceptable, and changes clinician behaviors. Future research should assess broader impact of training on clinicians, patients, and families.
儿科心脏重症监护病房(CICU)患儿的家长通常对家庭会议(FM)毫无准备。临床医生在与家属沟通时往往没有遵循最佳做法,这加剧了他们的痛苦。针对家庭会议的多专业团队干预是可行的、可接受的,并且对CICU中家庭会议的准备和召开产生积极影响。我们实施了一项支持家庭和团队的干预措施来召开家庭会议,并对入选参加家庭会议的患者的家长和临床医生进行了一项前后测研究。我们通过问卷调查和半结构化访谈来衡量可行性、对干预方案的依从性以及家长的接受度。通过对会议记录进行语义内容分析,跟踪家长关注问题的引出、向家长提出的问题以及对家长共情机会的回应,来评估临床医生在会议中的行为。逻辑回归和有序逻辑回归通过比较干预前后的数据,评估干预对临床医生在会议中沟通行为的影响。60位家长(占邀请人数的95%)参与了研究,收集到了97%的家庭会议数据和98%的问卷调查数据。我们对干预方案的依从性超过了85%。大多数家长(80%)表示,准备工作表的信息量恰到好处,并对家庭收到这份工作表持积极态度。在干预后的家庭会议中,临床医生更有可能引出家长关注的问题(调整后的优势比=3.42;95%置信区间[1.13, 11.0])。其余指标没有显著差异。实施多专业团队干预以改善家庭会议的准备和召开在当地是可行的、可接受的,并且会改变临床医生的行为。未来的研究应该评估培训对临床医生、患者和家庭的更广泛影响。