Physician communication with families during pediatric ECMO: results from a Delphi study

Abstract

Purpose To develop physician recommendations for communicating with families during pediatric extracorporeal membrane oxygenation (ECMO) in Canada and the USA. Methods We used the Delphi methodology, which consists of 3 iterative rounds. During Round 1, we conducted semi-structured interviews with each panelist, who were pediatricians from the USA and Canada from the following pediatric specialties: intensive care, cardiac intensive care, and neonatology. We then used content analysis to code the interviews and develop potential recommendations. During Round 2, panelists evaluated each item via a Likert scale as a potential recommendation. Before Round 3, panelists were provided personalized feedback reports of the results of Round 2. During Round 3, panelists re-evaluated items that did not reach consensus during Round 2. Items that reached consensus in Rounds 2 and 3 were translated into the final framework. Results Consensus was defined as (1) a median rating ≥ 7 and (2) ≥ 70% of the panelists rating the recommendation ≥ 7. The final framework included 105 recommendations. The recommendations emphasized the importance of clarifying the goal of ECMO, its time-limited nature, and the possibility of its discontinuation resulting in patient death. The recommendations also provide guidance on how to share updates with the family and perform compassionate discontinuation. Conclusion A panel of experts from Canada and the USA developed recommendations for communicating with families during pediatric ECMO therapy. The recommendations offer guidance for communicating during the introduction of ECMO, providing updates throughout the ECMO course, and during the discontinuation of ECMO. There are also points of disagreement on best communication practices which should be further explored.