Prognostic Conversations in the PICU: Are We Even Coming Close?*

McSherry, Megan; Kudchadkar, Sapna R.

doi:10.1097/pcc.0000000000002783

Cited by 4 publications

(7 citation statements)

References 15 publications

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“…The clinicians describe their approaches when managing refusals, and the impact of these decisions on their medical teams. This work echoes previous PCCM publications on the topics of therapeutic alliance between parents and physicians (15) and communications about prognosis (16–18). Our editorial writer also adds to our understanding with more context about the United States 1980 Uniform Determination of Death Act, the case of Jahi McMath, and a personal view (19).…”

Section: What Is To Be Learned From Refusals To Allow Examination For...supporting

confidence: 82%

Editor’s Choice Articles for August

Tasker

2023

Pediatric Critical Care Medicine

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Section: What Is To Be Learned From Refusals To Allow Examination For...supporting

confidence: 82%

Editor’s Choice Articles for August

Tasker

2023

Pediatric Critical Care Medicine

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“…on leading these types of discussions (1)(2)(3)(4)(5). Despite these challenges, clear clinician communication of prognostic information is a core component of information sharing in family-centered care (6).…”

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confidence: 99%

“…Navigating a discussion of prognosis is one of the most important, yet challenging conversations clinicians have with families of critically ill children. Conveying prognosis can be difficult because of three main factors: 1) uncertainty is often present and contributes to clinician and parental distress, 2) clinicians are reluctant to deliver bad news, and 3) clinicians may not have received communication skills training focused on leading these types of discussions (1–5). Despite these challenges, clear clinician communication of prognostic information is a core component of information sharing in family-centered care (6).…”

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confidence: 99%

“…Honest disclosure of prognosis to families has been shown to relieve anxiety, increase hope, and improve trust in the clinician (8). Literature describing prognostic conversations in the PICU is limited to families and physicians recalling the conversation and their experiences (5, 9). Although clear communication about prognosis is an essential aspect of informed, shared decision-making in the PICU, little is known about how pediatric intensivists convey prognosis.…”

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confidence: 99%

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Characteristics of Prognostic Statements During Family Conferences of Critically Ill Children

Gupta¹,

October²,

Wolfe³

2022

Pediatric Critical Care Medicine

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Discussion of prognosis is an essential component of decision-making family conferences in critical care. We do not know how clinicians convey prognosis to families of critically ill children. We, therefore, aimed to evaluate the frequency of prognostic statements and the message and meaning conveyed through each statement during PICU family conferences. DESIGN:Retrospective, mixed-methods study.SETTING: PICU of a single quaternary medical center. PATIENTS:Critically ill children and their families participating in PICU family conferences of critical medical decision-making. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:We analyzed 72 transcripts from audio-recorded PICU family conferences to identify prognostic statements. Descriptive, thematic content analysis was used to elucidate the message and meaning of each prognostic statement. Prognosis was not discussed in 26% (19/72) of family conferences. Of the other (53/72) conferences where prognostic statements were made, 60% (67/112) of statements conveyed a message (i.e., prognostic medical information) and a meaning (i.e., anticipated impact on patient/family). "Messages" of prognostic statements fell within eight themes: uncertain recovery, delayed recovery, progressive decline, escalation of support, attributable complications, no progress, irreversible, and probability of death. "Meanings" of prognostic statements fell within six themes: restoration of health, activities of daily living, additional equipment, prolonged care needs, brain dysfunction, and death. Broadly, clinicians discussed prognostic information in three categories: loss of Time (i.e., prolonged care needs), Function (i.e., additional medical equipment), or Cure (i.e., death). CONCLUSIONS:Nearly in half of discussions (32/72, 44%) where families were asked to make critical medical decisions, clinicians did not provide a prognostic statement including a message and meaning. When discussed, prognostic information was conveyed in three categories: loss of time, function, or cure. Providing families context in this framework, particularly in times of uncertainty, may improve the family's ability to make informed, value-driven medical decisions for their child.

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“…In the September 2021 issue of PCCM we featured a survey of 100 parents and PICU physicians and their conversations about prognosis (16). Our editorialists explored the implications of that research and provided a four-step plan toward improved communication within the multidisciplinary PICU team (17). Now, guess who has carried out the systematic review on the subject?…”

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confidence: 99%

Editor’s Choice Articles for January

Tasker

2023

Pediatric Critical Care Medicine

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Welcome to January 2023 and volume 24 of Pediatric Critical Care Medicine (PCCM). It is a great start to the year. I must draw your attention to my three Editor's Choice articles: a national Dutch PICU registry study of adverse events in seven units (1); an American Heart Association Get With the Guidelines-Resuscitation (GWTG-R) registry study of in-hospital cardiac arrest (IHCA) in adults who are managed in 17 PICUs in the United States (2); and, a retrospective study of SARS-CoV2 infection in nine PICUs in the United States (3). All three of these reports have accompanying editorials (4-6).

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Prognostic Conversations in the PICU: Are We Even Coming Close?*

Cited by 4 publications

References 15 publications

Editor’s Choice Articles for August

Editor’s Choice Articles for August

Characteristics of Prognostic Statements During Family Conferences of Critically Ill Children

Editor’s Choice Articles for January

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