Feasibility of an Intervention to Support Shared Decision-Making for Critically Ill Infants

Area of Science:

• Pediatric critical care medicine
• Health communication
• Bioethics

Background:

• Effective communication and shared decision-making are crucial for critically ill infants and their families.
• Existing interventions may not adequately address the unique challenges faced by parents and clinicians in neonatal intensive care units.
• The Building Rapport, Improving Dialogue, and Growing Empathy (BRIDGE) intervention was developed to enhance communication and decision-making processes.

Purpose of the Study:

• To develop and pilot the BRIDGE intervention for critically ill infants.
• To assess the feasibility and acceptability of the BRIDGE intervention among parents and clinicians.
• To explore the intervention's impact on parents' preparedness for decision-making.

Main Methods:

• A single-arm, mixed-methods, prospective feasibility study was conducted.
• The BRIDGE intervention includes a values clarification exercise and question prompts for parents.
• Feasibility was defined by enrollment (≥50%) and data collection (≥80%) rates; acceptability and preparedness for decision-making were secondary outcomes.

Main Results:

• The study achieved high enrollment (56%) and data collection (97%) rates, meeting feasibility criteria.
• Most parents and clinicians found the BRIDGE intervention helpful, recommending its future use.
• Parents reported high preparedness for decision-making (mothers: median 82; fathers: median 60). Qualitative themes included scaffolding, validation, preparation, and connection.

Conclusions:

• The BRIDGE intervention is feasible and acceptable for use with critically ill infants, parents, and clinicians.
• The intervention shows promise in supporting communication and decision-making in the neonatal intensive care unit.
• Future research should evaluate the BRIDGE intervention's impact on values-congruent decisions and clinical outcomes.