Project Description
Developing and Testing Criteria for Convening Family Conferences in the Pediatric Intensive Care Unit
Three
decades of research demonstrate inadequacies in intensive care unit (ICU)
communication. Poor ICU communication worsens patient care and family mental
health outcomes. Conversely, high-quality ICU communication supports care that
meet the needs of patients and their families while mitigating the
psychological impact of critical illness on families. Experts recommend routine
multidisciplinary ICU family conferences (FCs) to improve communication. FCs
are planned meetings (excluding bedside rounds) with healthcare team members
and patients and/or patient surrogates to discuss or determine treatment plans.
Data about ICU FCs, mostly from studies of adult patients facing end-of-life
care issues, show that FCs may enhance families’ satisfaction with
communication and trust in clinicians, reduce clinician-family conflict, and
support shared decision making. But such data have limited application in the
pediatric intensive care unit (PICU) which serves a notably different population
than adult ICUs. Also, current recommendations do not specify which PICU
patients we should offer FCs. Our long-term goal is to positively impact
healthcare outcomes for PICU patients and their families by improving PICU
communication. The proposed project will develop and pilot reliable and
inclusive (i.e., highly sensitive) criteria for determining which PICU families
to offer FCs and obtain needed information about factors associated with PICU
FC use and how parents view PICU FCs. We will: (1) develop reliable criteria
for determining which PICU families to offer an FC; (2) assess the inclusivity
of our developed FC criteria; and (3) describe parents’ views of PICU FCs and
factors associated with having PICU FCs. This innovative research will culminate
in inclusive and reliable criteria defining a target population for PICU FCs
and obtain novel data about factors associated with PICU FC use and parents’
views about PICU FCs. These data will inform future studies aimed at improving
PICU communication.
Bio
Kelly Michelson, MD, MPH, is Professor
of Pediatrics, Julia and David Uihlein Professor of Bioethics and Medical
Humanities, and Director of the Center for Bioethics and Medical Humanities at
Northwestern University Feinberg School of Medicine. She is an attending
physician at Ann & Robert H. Lurie Children’s Hospital of Chicago in the
division of pediatric critical care medicine. Dr. Michelson’s research
interests include communication, decision making, palliative care, bereavement
support, and bioethics. She uses qualitative and quantitative methods as well
as patient/stakeholder engagement and community-based participatory research methods.
Recent work has examined the use of a navigator in the pediatric intensive care
unit setting, the role of social workers and spiritual care providers for
critically ill pediatric patients with cancer, and access to bereavement
support for people impacted by the death of a child.
Email: KMichelson@luriechildrens.org