A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention

Abstract

Objectives: Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. Design: Patient-level, randomized trial. Setting: Two university-based, tertiary-care children’s hospital PICUs. Participants: Parents of patients requiring more than 24 hours in the PICU. Interventions: PICU Supports included adding a trained navigator to the patient’s healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. Measurements and Main Results: The primary outcome was percentage of “excellent” responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3–5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3–5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; se, 4.53; 95% CI, –5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as “extremely” or “somewhat” helpful. Conclusions: Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.

Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis

“…However, interdisciplinary perspective (e.g., behavioral psychology, palliative care) should also inform intervention design. We found limited evidence of successful interventions for surrogates in similar contexts (e.g., pediatric acute/critical care) (62–65), thus highlighting the need for further investigation in this field.…”

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence

“…Some hospital systems have formalized partnership programs to address these needs. Inclusion of a trained navigator who provides emotional, communication, decision-making, information, and transition support to the patient’s healthcare team has garnered preliminary support, though the research has been underpowered [ 104 ]. A study on a mother-nurse partnership program for parents of infants in a pediatric cardiac ICU also yielded promising results [ 105 ].…”

Prognostic and Goals-of-Care Communication in the PICU: A Systematic Review

“…Michelson et al (42) performed a multi-institutional prospective randomized clinical trial that incorporated a PICU navigator-based caregiver support intervention. Although statistically insignificant, caregivers reported a positive impact on communication quality and timeliness, conversations about caregiver values and preferences, the hospital experience, and the family centeredness of care.…”