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Challenges to code status discussions for pediatric patients.

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Pediatric providers show poor understanding of code status options and differing comfort levels discussing end-of-life care. This knowledge gap and varied perceptions hinder effective communication with families about resuscitation efforts.

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Area of Science:

  • Pediatric critical care medicine
  • Medical ethics
  • Healthcare communication

Background:

  • Pediatric patients with serious illnesses face complex end-of-life decisions regarding resuscitation.
  • Code status orders are crucial for guiding medical decision-making in these situations.
  • Understanding provider knowledge and perceptions is vital for improving end-of-life care discussions.

Purpose of the Study:

  • To assess pediatric providers' knowledge of code status options.
  • To explore how provider roles influence knowledge, timing perception, family receptivity perception, and comfort with code status discussions.
  • To identify barriers in end-of-life care communication for pediatric patients.

Main Methods:

  • A survey questionnaire was administered to nurses, trainees, and attending physicians in high-acuity pediatric units.
  • The survey assessed knowledge of code status options and perceptions of code status discussions.
  • Data were analyzed to compare responses across different provider roles.

Main Results:

  • Only 22% of providers could name more than two of four code status options, indicating poor objective knowledge.
  • Attending physicians reported higher self-assessed familiarity with code status options compared to nurses and trainees.
  • Significant differences were found in perceptions of discussion timing, family receptivity, and provider comfort levels based on role.

Conclusions:

  • Pediatric providers exhibit a significant lack of understanding regarding available code status options.
  • Discrepancies in comfort and perception among provider roles may indicate differing views on appropriate care and contribute to moral distress.
  • Gaps in knowledge and perception present barriers to effective communication about end-of-life care options for pediatric patients and their families.