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Provider Consensus on Candidate Protective and Risk Factors for Adverse Psychosocial Outcomes Following Discharge
Conrad S P Williams1, Daniel H Grossoehme2,3, Michael L Forbes4
1Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Insights
Identifying social determinants of health and clinical factors is crucial for improving psychosocial outcomes after pediatric intensive care unit (PICU) admission. Pediatric palliative care can enhance caregiver satisfaction and family engagement with social services.
Area of Science:
- Pediatric critical care medicine
- Palliative care
- Public health
Background:
- Pediatric palliative care offers interdisciplinary, family-centered support for children with life-limiting conditions.
- A knowledge gap exists in optimizing pediatric palliative care for the psychosocial impact of pediatric intensive care unit (PICU) admissions.
- Understanding social determinants of health (SDOH) is vital for addressing post-PICU psychosocial outcomes.
Purpose of the Study:
- To identify key drivers of adverse psychosocial outcomes post-PICU admission, focusing on SDOH.
- To inform the development and refinement of pediatric palliative care services.
- To improve the psychosocial well-being of children and families after PICU discharge.
Main Methods:
- A modified Delphi technique was employed to achieve consensus among experts.
- Surveys were electronically distributed to clinicians in PICU and pediatric palliative care.
- Consensus was defined as achieving a score of ≥4 (on a 5-point scale) from >75% of respondents.
Main Results:
- Identified SDOH risk factors include child protective services involvement, caregiver intellectual disability, lack of social support, and caregiver behavioral health diagnoses.
- Key clinical risk factors include new home ventilator or tracheostomy, and multiple prior hospitalizations.
- Protective factors include extended family support, committed caregiver relationships, and caregiver optimism.
Conclusions:
- Consensus was reached on critical risk and protective factors influencing post-PICU psychosocial challenges.
- Pediatric palliative care significantly impacts caregiver satisfaction and family engagement with social services.
- Further research is needed to develop and prospectively validate a screening tool based on these findings.
Objectives:
Pediatric palliative care promotes interdisciplinary, family-centered care when children are faced with diagnoses threatening length and/or quality of life. A significant knowledge gap remains in how to best match pediatric palliative care resources to palliate the psychosocial impact of a PICU admission. This study was designed to identify drivers of adverse post-PICU psychosocial outcomes related to social determinants of health to inform pediatric palliative care services and improve post-PICU psychosocial outcomes.
Design:
Modified Delphi technique to develop consensus regarding social determinants of health and clinical factors affecting post-ICU psychosocial outcomes.
Setting:
All Delphi rounds were via an electronically mailed survey link.
Subjects:
First-round participants were PICU and pediatric palliative care clinicians at the study institution. Subsequent rounds invited participants from national PICU and pediatric palliative care professional online listserves.
Interventions:
None.
Measurements And Main Results:
Consensus was defined a priori as items assigned a score greater than or equal to 4 (5-point scale) by greater than75% of respondents. One-hundred twenty-six surveys were returned and scored. Social determinants of health risk factors included child protective services involvement (91%), caregiver with intellectual disability (87%), lack of friend or family support (82%), caregiver with behavioral health diagnosis (81%), teenage caregiver (79%), transportation challenges (79%), and language/cultural barrier (76%). Clinical risk factors included new home ventilator (94%), new tracheostomy (90%), greater than or equal to 3 hospitalizations in the prior 6 months (88%), and greater than or equal to 3 hospitalizations in the prior 12 months (82%). Social determinants of health protective factors included extended family support (91%), caregivers in a committed relationship (79%), and caregiver optimism (78%). Respondents reported that pediatric palliative care services had the greatest impact on caregiver satisfaction with the healthcare system (90%) and increased family involvement with state social services programs (80%).
Conclusions:
Consensus on candidate risk and protective factors for post-ICU psychosocial challenges and candidate pediatric palliative care-sensitive variables were identified. Further research is needed to operationalize and optimize a screening tool based on these consensus items and test it prospectively.
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