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Advance Care Discussions: Pediatric Clinician Preparedness and Practices
Amy Sanderson1, Amber M Hall1, Joanne Wolfe2
1Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Pediatric clinicians feel prepared for advance care discussions (ACD), but their practices often don't align with best practices. More training and support are needed to improve ACD skills for children with life-threatening conditions.
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.
Context:
Few data exist regarding clinician preparedness to participate in advance care discussions (ACD) and the practices surrounding these discussions for children with life-threatening conditions.
Objectives:
We sought to understand pediatric clinician preparedness to participate in ACD and the practices surrounding these discussions.
Methods:
A survey was administered to assess clinician attitudes and behaviors regarding ACD.
Results:
Two hundred sixty-six clinicians (107 physicians and 159 nurses) responded to the survey (response rate 53.6%). Seventy-five percent of clinicians felt prepared to participate in ACD. Most clinicians believed they were prepared to express empathy (98.8%), discuss goals of care for an adolescent patient (90.3%), and elicit a parent's hopes (90.3%). Conversely, several felt unprepared to discuss resuscitation status with school-aged (59.7%) and adolescent (48.5%) patients and to conduct a family conference (39.5%). The most frequent topics addressed were: parents' understanding of the patient's illness (75.5%), primary goals of the parent (75.1%), and the parents' understanding of prognosis (71.1%). Conversely, the topics least commonly discussed were as follows: belief system of the patient/family (22.0%), patient's hopes (21.2%), and the patient's perceptions of his/her quality of life (19.8%). Notably, 40% of clinicians believe that caring for patients with poor prognoses is depressing, and this was more common among less-experienced clinicians (P = 0.048).
Conclusion:
Many clinicians believe they are prepared to participate in ACD, but practices are not consistent with expert recommendations for optimal ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and behavior, and greater clinician support may enhance health care provider ACD preparedness and skills.
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