Lemmon Monica E, Bansal Simran, Nanduri Nikhita, Davalos Angel, Glass Hannah C, Lord Blyth, Moline Katrina, Pilon Betsy, Sharpe Rose, Brandon Debra, Hong Hwanhee, Samsa Greg, Cox Christopher E, Pollak Kathryn I
Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
Department of Pediatrics, Duke University School of Medicine, Durham, NC.
J Pediatr. 2025 Aug;283:114632. doi: 10.1016/j.jpeds.2025.114632. Epub 2025 May 2.
To develop and pilot an intervention to support communication and decision-making for critically ill infants.
In this single-arm, mixed-methods, prospective, feasibility study, we enrolled infants, parents, and clinicians at a single tertiary care center. The Building Rapport, Improving Dialogue, and Growing Empathy intervention contains a values clarification exercise and question prompt list that parents can opt to share with the health care team. Parent and clinician participants completed surveys and semistructured interviews ≥72 hours postintervention. The primary outcome was intervention feasibility, defined as an enrollment rate ≥50% and a complete data collection rate ≥80%. Secondary outcomes included intervention acceptability and preparation for decision-making (Preparedness for Decision-Making Scale, score: 0-100, higher scores indicating higher preparedness). Statistical analyses were descriptive, and interviews were analyzed using a rapid-cycle qualitative approach.
Thirty clinicians and 44 parents of 30 infants were enrolled (enrollment rate: 56%; complete data collection rate: 97%). The majority of parents and clinicians endorsed the tool as helpful, would recommend the tool to other parents, and would use the tool in the future. Preparedness for decision-making was high for both mothers (median score = 82, IQR: 70.0-90.0) and fathers (median score = 60, IQR: 38-74). Qualitative analysis of the intervention's impact identified 4 themes: (1) providing a scaffold; (2) validating and affirming experience; (3) preparing for a conversation; and (4) facilitating connection.
The Building Rapport, Improving Dialogue, and Growing Empathy intervention was feasible and acceptable to parents and clinicians. Future work should assess its impact on values-congruent decision-making, therapeutic alliance, and infant outcomes.
NCT05733975.
开发并试行一项干预措施，以支持危重症婴儿的沟通与决策。
在这项单臂、混合方法、前瞻性可行性研究中，我们在一家三级医疗中心招募了婴儿、家长和临床医生。“建立融洽关系、改善对话、增强同理心”干预措施包含一项价值观澄清练习和一份问题提示清单，家长可选择与医疗团队分享。家长和临床医生参与者在干预后≥72小时完成了调查和半结构化访谈。主要结局是干预的可行性，定义为入组率≥50%且完整数据收集率≥80%。次要结局包括干预的可接受性以及决策准备情况（决策准备量表，得分：0 - 100，得分越高表明准备越充分）。统计分析为描述性分析，访谈采用快速循环定性方法进行分析。
招募了30名临床医生以及30名婴儿的44名家长（入组率：56%；完整数据收集率：97%）。大多数家长和临床医生认可该工具有用，会向其他家长推荐该工具，并会在未来使用该工具。母亲（中位数得分 = 82，四分位间距：70.0 - 90.0）和父亲（中位数得分 = 60，四分位间距：38 - 74）的决策准备程度都很高。对干预影响的定性分析确定了4个主题：（1）提供框架；（2）验证和肯定经验；（3）为对话做准备；（4）促进联系。
“建立融洽关系、改善对话、增强同理心
