Tracheostomy decision-making for children with medical complexity: What supports and resources do caregivers need?

Abstract

Objectives Caregivers of children with medical complexity (CMC) face decisions about life-sustaining interventions, such as tracheostomy. Our objective is to describe the support needs of caregivers of CMC and the resources they use surrounding tracheostomy decision-making (TDM) for their children. Methods This qualitative study, conducted between 2013 and 2015, consisted of semi-structured interviews with 56 caregivers of 41 CMC who had tracheostomies, and 5 focus groups of 33 clinicians at a tertiary care children's hospital. Participants were asked about their perspectives on the TDM process. Qualitative data were transcribed, coded, and organized into themes. Results Caregivers used five domains of resources surrounding TDM: (1) social network including extended family members, friends, and clergy; (2) healthcare providers including physicians and nurses; (3) other parents of children with tracheostomy; (4) tangible materials such as print materials, videos, tracheostomy tubes, mannequins, and simulation labs; and (5) internet including websites, social media, and online health communities. Caregivers used these resources for (1) decision-making, (2) becoming knowledgeable and skillful about child's diagnosis, tracheostomy, and home care, and (3) emotional and spiritual well-being. Caregivers agreed that they received enough support, but there were gaps. Clinicians were knowledgeable about these resources, discussed social network and internet less often than the other domains, and identified gaps in supporting caregivers. Significance of results Caregivers’ need for support and use of resources surrounding tracheostomy placement for CMC extended beyond decision-making, and included becoming knowledgeable and getting emotional/spiritual support. Healthcare providers exploring these resources with caregivers could improve the quality of TDM communication.

Collaborative decision‐making: A framework for decision‐making about life‐sustaining treatments in children with medical complexity

“… a Data presented here were previously published in other papers from this project. 10 , 11 , 12 , 13 …”

“…Information from other parents—either obtained through connections facilitated by clinicians or through the internet—was also a factor. 13 Preserving their children's lives was the most important factor for caregivers. 12 Many caregivers had no prior knowledge of or experience with tracheostomy.…”

“…A qualitative approach is the most rigorous methodology to understand the perspectives of participants, explore the meanings of phenomena, or observe a process in depth, 15 all of which apply to this study. Methodological details are provided in the Standards for Reporting Qualitative Research 16 checklist (Appendix ) and described previously 10–13 …”

“…Methodological details are provided in the Standards for Reporting Qualitative Research 16 checklist (Appendix SA) and described previously. [10][11][12][13] 2.2 | Participants, recruitment, and data collection…”

“…We used qualitative methodology in a research project to understand the pediatric tracheostomy decision‐making process from the perspectives of caregivers and HCPs. In four previously published 10 , 11 , 12 , 13 papers from this project, we described different aspects of the pediatric tracheostomy decision‐making process. Building on these, in this paper, we describe a model of pediatric tracheostomy decision‐making.…”