Amy Wolfe, MD
Attending Physician
Children's National
Washington, D.C., District of Columbia
Disclosure information not submitted.
Sarah Ray, M.D. Candidate 2022
M.Ed.
East Tennessee State University, United States
Disclosure information not submitted.
Lamia Soghier, MD, FAAP
Associate Professor of Pediatrics
Children's National
Washington, District of Columbia, United States
Disclosure information not submitted.
Pamela Hinds, PhD, RN, FAAN
Executive Director, Department of Nursing Science, Professional Practice & Quality
Children's National, United States
Disclosure information not submitted.
Heather Gordish, PhD
Associate Research Professor of Genomics and Precision Medicine
Children's National Hospital, United States
Disclosure information not submitted.
Robert Arnold, M.D.
Leo H. Creip Professor of Medicine
University of Pittsburgh, United States
Disclosure information not submitted.
Title: An Exploration of Pediatric Trainee Comfort in End-of-Life Communication
Introduction:
Effective communication can decrease symptoms of stress, anxiety, and depression for family members of critically ill patients. A variety of communication training programs designed to improve trainees’ communication skills are available, but the dissemination to pediatric residents is unknown. We aimed to explore the current status of communication training received by incoming Pediatric Intensive Care Unit (PICU) fellows during their pediatric residency experience and assess self-perceived gaps.
Methods:
A prospective cross-sectional survey-based study was administered to Pediatric residents attending a national PICU fellow bootcamp. Descriptive statistics were used to define the cohort and their self-perceived comfort surrounding end-of-life (EOL) communication. The cohort was stratified by those who reported “substantial experience” verses those who reported “seldom or no experience” in caring for patients in their last few weeks of life and analyzed using a student’s t-test for continuous responses or a Fisher’s exact test for categorical responses.
Results:
50% of bootcamp participants accessed the survey (72/143) and 40 surveys were completed in entirety. The majority (62.5%) had seldom or no experience caring for patients in the last few weeks of life. Those with substantial experience (37.5%) felt better trained in responding to emotional parents than their lesser experienced peers (P = 0.001). The minority of respondents felt well-trained in domains surrounding EOL care, such as giving bad news to families (20%), leading a family meeting (5%), discussing treatment options (18%), discussing code status (23%) and discussing religious or spiritual issues (8%).
Conclusions:
Communicating with patients and families in the PICU is challenging for providers, especially at the EOL. Lack of exposure to caring for patients in their last few weeks of life highlights the importance of a specialized communication training for pediatric intensivists to improve comfort and skill in these challenging communication encounters.