Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

Abstract

ObjectivesTo explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.DesignQualitative semistructured interview study.SettingOne region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation.ParticipantsA purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre.InterventionInterviews undertaken by telephone or video link.Primary and secondary outcome measuresQualitative reflexive thematic analysis with QSR Nvivo 12.ResultsThis paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies.ConclusionsUnderstanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.

A systematic review of antimicrobial therapy in children with tracheostomies

“…Most children with tracheostomies will experience ongoing airway complications, of which respiratory tract infections are the most common, accounting for over a fifth of hospital readmissions in this group 2,11,14–16 . Complications increase the frequency of patients' hospital visits and healthcare costs; they can also impair the quality of life of children and their carers 4,6,14,17,18 . A retrospective cohort study reporting healthcare costs for 1122 children who underwent tracheostomy insertion in England over a 5‐year period reported 1213 hospital admissions for lower respiratory tract infections (LRTI) in the first year after tracheostomy alone, costing £8,446,138 ($11,554,072) 16 .…”

“…2,11,[14][15][16] Complications increase the frequency of patients' hospital visits and healthcare costs; they can also impair the quality of life of children and their carers. 4,6,14,17,18 A retrospective cohort study reporting healthcare costs for 1122 children who underwent tracheostomy insertion in England over a 5-year period reported 1213 hospital admissions for lower respiratory tract infections (LRTI) in the first year after tracheostomy alone, costing £8,446,138 ($11,554,072). 16 Children with tracheostomies are frequently treated with broad-spectrum antimicrobials for the prevention or treatment of respiratory tract infections.…”