Advance Care Discussions: Pediatric Clinician Preparedness and Practices

Area of Science:

• Pediatric Palliative Care
• Clinical Communication
• Medical Ethics

Background:

• Limited data exist on clinician readiness for advance care discussions (ACD) in children with life-threatening conditions.
• Understanding current practices and preparedness is crucial for improving pediatric end-of-life care.

Purpose of the Study:

• To assess pediatric clinician preparedness for ACD.
• To examine the practices and challenges associated with ACD in pediatric care.

Main Methods:

• A survey was administered to pediatric physicians and nurses.
• The survey assessed clinician attitudes, self-perceived preparedness, and behaviors regarding ACD.

Main Results:

• 75% of clinicians felt prepared for ACD, particularly in expressing empathy and discussing goals of care.
• Clinicians reported less preparedness in discussing resuscitation status and conducting family conferences.
• Commonly discussed topics included parental understanding of illness and prognosis, while patient-specific hopes and beliefs were less frequently addressed.
• A significant portion of clinicians found caring for patients with poor prognoses depressing, especially less experienced ones.

Conclusions:

• While many clinicians feel prepared for ACD, their practices may not meet expert recommendations.
• Educational interventions and enhanced clinician support are recommended to improve ACD preparedness and skills.
• Addressing clinician attitudes, knowledge, and behaviors is key to optimizing ACD for critically ill children.