Related Experiment Video
Updated: Jul 4, 2025
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Perceived potentially inappropriate treatment in the PICU: frequency, contributing factors and the distress it
Amrita Sarpal1,2, Michael R Miller1,2, Claudio M Martin3,4
1Department of Paediatrics, Children's Hospital - London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Insights
Potentially inappropriate treatment in critically ill children was infrequent, but provider distress was common. Understanding factors contributing to this distress can help improve care and support for healthcare providers.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Ethics
- Healthcare Provider Well-being
Background:
- Potentially inappropriate treatment (PIT) in critically ill adults is linked to healthcare provider distress and burnout.
- Limited knowledge exists regarding PIT perception among pediatric healthcare providers.
Purpose of the Study:
- To determine the frequency and factors of perceived PIT in critically ill children.
- To describe factors contributing to provider distress when delivering perceived PIT.
Main Methods:
- Prospective observational mixed-methods study in a tertiary pediatric intensive care unit (PICU).
- Included critically ill children (0-17 years) with organ dysfunction, severe disabilities, or technology dependence.
- Assessed perceived PIT frequency and provider distress using a 100-point scale and thematic analysis.
Main Results:
- 18 of 133 eligible patients were perceived to receive PIT; unanimous consensus predicted 100% mortality.
- 53% of providers reported distress related to perceived PIT.
- Key distress factors included suffering, conflict, quality of life, resource use, and uncertainty.
Conclusions:
- Perceived PIT in critically ill children is infrequent, but provider distress is common.
- Identifying factors contributing to perceived PIT and distress is crucial for targeted interventions.
- Organizations can use these findings to develop strategies to support healthcare providers and improve patient care.
Background:
Potentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited.
Objectives:
Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate.
Methods:
Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale.
Results:
Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty.
Conclusions:
While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.
More Related Videos
08:25Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment
Published on: December 6, 2024
09:55Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder
Published on: March 8, 2018
Related Concept Videos
01:27Post-traumatic Stress Disorder
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:30Pneumonia III: Complications and Assessment
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:29Pneumonia II: Pathophysiology
01:30Acute Respiratory Failure-III