Lauren Rissman, MD
Pediatric Palliative Care Fellow
Ann and Robert H Lurie Childrens Hospital of Chicago
Los Angeles, California
Disclosure information not submitted.
Sabrina Derrington, MD
Dr.
Children's Hospital Los Angeles
Los Angeles, California, United States
Disclosure information not submitted.
Kelly Michelson, MD
Director of Bioethics
Northwestern University, United States
Disclosure information not submitted.
Title: Parent and Physician Report of Prognostic Discussions in the Pediatric Intensive Care Unit
Introduction: While most pediatric patients survive critical illness, many experience new morbidities during their pediatric intensive care unit (PICU) admission and post-discharge. Patients and families rely on ICU providers to discuss potential morbidities and mortality, and help prepare for challenges associated with poor outcomes. We describe PICU parent and attending physician reports about prognostic conversation occurrence, with whom parents had conversations, and whether parents want more prognostic information.
Methods: For ICU patients with multiorgan dysfunction within 24 hours of admission, we surveyed parents and attending physicians at PICU discharge. Surveys asked parents and physicians to report the occurrence of prognostic conversations during the admission related to: mortality, anticipated post-PICU physical, neurological, and psychological morbidities for patients, and post-PICU psychological morbidities for parents.
Results: We received surveys from parents and attending physicians of 49 patients. 30 parents and 29 matched physicians reported having prognostic conversations. Average patient length of stay was 18.8 days. Overall concordance between parents and physicians was slight (kappa= .19). Parents and physicians most commonly reported prognostic conversations about post-PICU physical morbidity (n=22, 44.9% and n=23, 46.9%, respectively). Parents reported conversations about patient mortality and post-PICU cognitive morbidity least (n=9, 18.4% and n=10, 20.4%, respectively). Per parent report, bedside nurses and physicians provided most prognostic information. Social workers (7/13, 53.8%) were more involved in conversations about parent psychological morbidities. 63% (17/27) of parents requested more information about their child’s physical morbidities if conversations had not occurred and 18.2% (4/22) requested more information even when conversations had occurred.
Conclusions: Most parents and physicians report having prognostic conversations, primarily about post-ICU physical morbidities. At discharge, up to 2/3 of parents are interested in learning more about potential post-ICU morbidities. Given the expressed desire from parents for additional prognostic information, more research is needed to understand better how and when providers should have prognostic conversations with parents.