Characteristics of Prognostic Statements During Pediatric Intensive Care Family Conferences
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Patient and Family Support, Pediatrics, 2022
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INTRODUCTION/HYPOTHESIS: Discussion of prognosis is a vital component of communication during pediatric intensive care unit (PICU) family conferences when medical decision-making is anticipated. Prior studies demonstrate that sharing clear, meaningful prognostic information positively impacts parental hope, satisfaction, and medical decision-making. For effective communication, the prognosis statement must contain a message, defined as a forecasting of the probable course of a disease, and a meaning, which delineates the impact of the disease on the patient and/or family. The current practice of how the healthcare team communicates prognosis to parents of critically ill children in the PICU is unknown. We evaluated the frequency and characteristics of prognostic statements made by the healthcare team during PICU decision-making family conferences. METHODS: We conducted a retrospective, qualitative study analyzing transcripts of audio-recorded PICU family conferences where critical decision-making was anticipated. Descriptive, thematic content analysis was applied to the transcripts to identify 1) the presence of prognostic statements and 2) the message and meaning of the prognostic statements. RESULTS: Seventy-two transcripts were analyzed, of which 53 (74%) included at least one prognostic statement. Clinicians made a total of 112 prognostic statements, of which 66 (59%) included both a message and a meaning, such as “your child’s lungs are worsening (message) and extubation will be unsuccessful (meaning).” Conversely, 46/112 (41%) statements included a message only, such as “your child’s lungs are worsening.” Messages fell into 4 themes: Time (fast vs. slow recovery), Disability (need for medical technology), Cure (reversibility of disease), and Additional disease (brain injury will lead to respiratory problems). CONCLUSIONS: Prognosis was discussed in the majority of family conferences of critical decision-making in the PICU, yet clinicians didn’t discuss prognosis 26% of the time. When prognosis was discussed, 41% of the time clinicians struggled to provide meaning to families regarding how this life-altering news may impact the patient and family. Providing context to the prognosis is essential for families to understand the prognosis and plan for the future.
Meta Tag
Content Type Presentation
Knowledge Area Patient and Family Support
Knowledge Area Pediatrics
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Medical Legal Issues
Tag Pediatrics
Tag Palliative Care
Tag Communication
Year 2022
Divya Gupta
Pediatric Critical Care Medicine Fellow
prognostic statements
pediatric intensive care family conferences
prognosis communication


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