Provider Consensus on Candidate Protective and Risk Factors for Adverse Psychosocial Outcomes Following Discharge From a PICU: A Modified Delphi Study*

Williams, Conrad; Grossoehme, Daniel H.; Forbes, Michael L.; Friebert, Sarah

doi:10.1097/pcc.0000000000002158

Cited by 8 publications

(3 citation statements)

References 35 publications

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“…Little research has attempted to assess TIC readiness in the PICU, specifically, but a few studies have assessed providers’ knowledge of and attitudes toward psychosocial interventions more broadly. One modified Delphi-method study of PICU and pediatric palliative care providers found that extended family support, caregivers being in a committed relationship, and caregiver optimism were viewed as consensus protective factors [ 48 ]. Another study used qualitative methods to capture the perspectives of emergency, intensive care, and acute care providers on psychosocial interventions following severe TBI [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Prolonged PICU admission is associated with social isolation (2, 82) and with greater parental anxiety and depression (83). Finally, postdischarge adverse psychologic outcomes in families are thought to be particularly common with some archetypal severe chronic illnesses, such as tracheostomy and initiation of long-term ventilation (84).…”

Section: Impact Of Critical Illness On Children With Severe Chronic I...mentioning

confidence: 99%

The Child With Severe Chronic Illness in the ICU: A Concise Review

Edwards

Goodman

2022

Critical Care Medicine

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OBJECTIVES:Children with severe chronic illness are a prevalent, impactful, vulnerable group in PICUs, whose needs are insufficiently met by transitory care models and a narrow focus on acute care needs. Thus, we sought to provide a concise synthetic review of published literature relevant to them and a compilation of strategies to address their distinctive needs.DATA SOURCES: English language articles were identified in MEDLINE using a variety of phrases related to children with chronic conditions, prolonged admissions, resource utilization, mortality, morbidity, continuity of care, palliative care, and other critical care topics. Bibliographies were also reviewed. STUDY SELECTION:Original articles, review articles, and commentaries were considered.DATA EXTRACTION: Data from relevant articles were reviewed, summarized, and integrated into a narrative synthetic review. DATA SYNTHESIS:Children with serious chronic conditions are a heterogeneous group who are growing in numbers and complexity, partly due to successes of critical care. Because of their prevalence, prolonged stays, readmissions, and other resource use, they disproportionately impact PICUs. Often more than other patients, critical illness can substantially negatively affect these children and their families, physically and psychosocially. Critical care approaches narrowly focused on acute care and transitory/rotating care models exacerbate these problems and contribute to ineffective communication and information sharing, impaired relationships, subpar and untimely decision-making, patient/family dissatisfaction, and moral distress in providers. Strategies to mitigate these effects and address these patients' distinctive needs include improving continuity and communication, primary and secondary palliative care, and involvement of families. However, there are limited outcome data for most of these strategies and little consensus on which outcomes should be measured. CONCLUSIONS:The future of pediatric critical care medicine is intertwined with that of children with serious chronic illness. More concerted efforts are needed to address their distinctive needs and study the effectiveness of strategies to do so.

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“…Although LTV can relieve these symptoms and be life‐prolonging, it is not curative, does not mitigate other comorbidities or life‐limiting conditions that these children commonly have, and confers its own risks for morbidity and mortality. Furthermore, LTV often requires constant, complex care, which can lead to physical, emotional, financial, and other burdens for the family 2,3–5 . Therefore, forgoing LTV is morally permissible in some situations.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a novel informational booklet for pediatric long‐term ventilation decision support

Edwards

Panitch

George

et al. 2020

Pediatric Pulmonology

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Objectives To provide accessible, uniform, comprehensive, and balanced information to families deciding whether to initiate long‐term ventilation (LTV) for their child, we sought to develop and validate a novel informational resource. Methods The Ottawa Decision Support Framework was followed. Previous interviews with 44 lay and 15 professional stakeholders and published literature provided content for a booklet. Iterative versions were cognitive tested with six parents facing decisions and five pediatric intensivists. Ten parents facing decisions evaluated the booklet using the Preparation for Decision Making Scale and reported their decisional conflict, which was juxtaposed to the conflict of 21 parents who did not read it, using the Decisional Conflict Scale. Twelve home ventilation program directors evaluated the booklet's clinical sensibility and sensitivity, using a self‐designed six‐item questionnaire. Data presented using summary statistics. Results The illustrated booklet (6th‐grade reading level) has nine topical sections on chronic respiratory failure and invasive and noninvasive LTV, including the option to forgo LTV. Ten parents who read the booklet rated it as helping “Quite a bit” or more on all items of the Preparation for Decision Making Scale and had seemingly less decisional conflict than 21 parents who did not. Twelve directors rated it highly for clinical sensibility and sensitivity. Conclusions The LTV booklet was rigorously developed and favorably evaluated. It offers a resource to improve patient/family knowledge, supplement shared decision‐making, and reduce decisional conflict around LTV decisions. Future studies should validate it in other settings and further study its effectiveness.

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Provider Consensus on Candidate Protective and Risk Factors for Adverse Psychosocial Outcomes Following Discharge From a PICU: A Modified Delphi Study*

Cited by 8 publications

References 35 publications

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

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

The Child With Severe Chronic Illness in the ICU: A Concise Review

Development and validation of a novel informational booklet for pediatric long‐term ventilation decision support

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