Sharing Life-Altering Information: Development of Pediatric Hospital Guidelines and Team Training

Abstract

Background: Despite parent and physician reports of inadequate skill development, there are few guidelines for training the pediatric care team in sharing life-altering information (SLAI), i.e., ''breaking bad news.'' The necessary skills for SLAI differ between pediatric and adult medical environments. Objectives: We set out to establish evidence-based guidelines and multidisciplinary team training for SLAI in pediatrics, and to demonstrate an improvement in immediate self-efficacy of training participants. Methods: A multidisciplinary task force, which included parent participation and feedback, and which received input from parents of patients in multiple pediatric subspecialties, crafted children's hospitalwide guidelines for SLAI. A one-hour training module on the guidelines was presented to several multidisciplinary pediatric team audiences; 159 voluntary pre-and post-presentation self-efficacy surveys were collected. Responses were analyzed by paired t-test (within groups) and ANOVA (between groups). Results: All evaluated groups of care team members reported significant improvements in self-efficacy among four learning objectives after the training. Medical trainees, newer physicians, and nonphysician (e.g., midlevel providers including nurses) team members reported the greatest improvements, regardless of whether they had received previous training in SLAI. Conclusions: We propose pediatric-focused SLAI guidelines based on a modified SPIKES protocol. Focus on patient-and family-centered, culturally sensitive pediatric practices should be the basis for development of training that can be periodically reinforced. Future comprehensive training will incorporate experiential learning. SLAI requires a skill set that benefits from lifelong learning.

Feasibility and Effectiveness of a Mnemonic Approach to Teach Residents How to Assess Goals of Care

“…We are aware of only one other tool that approaches this conversation from a similar framework. 6 Models currently exist and have been studied for ''Breaking Bad News,'' [7][8][9][10][11] or having GOC discussions when a patient is in the terminal stage of their disease. [12][13][14][15] Education surrounding how to deliver bad news is integral to medical training; however, this skill set, in which one party is the ''giver'' of information and the other a ''receiver,'' is very different from a shared decision-making process making treatment decisions that are affected by personal values, goals, and preferences.…”

Bad News Deserves Better Communication: A Customizable Curriculum for Teaching Learners to Share Life-Altering Information in Pediatrics

“…8 The modifications of SPIKES (including changing invitation to involvement ) for pediatric practice were made in order to refocus on avoiding paternalism and emphasizing patient- and family-centered care. 9 The initial guidelines were taught as a simple 1-hour didactic session, and this didactic material is currently being used as required initial exposure to this topic for pediatric trainees at UW. This approach has been validated for improving provider self-efficacy.…”

“…This approach has been validated for improving provider self-efficacy. 9 Subsequently, a hands-on experience derived from this work was offered as a 90-minute workshop at the American Society of Pediatric Hematology/Oncology (ASPHO) annual meeting on May 8, 2015. Approximately 60 attendees, primarily fellows in pediatric hematology/oncology, participated, along with some advanced practice providers and faculty.…”

Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions

“…The centrality of the role of communication in medicine is indisputable, as evidenced, for example, by the literature relating to breaking bad news to patients [2][3][4][5], doctor-patient communication [6][7][8][9][10] and communication skills training for clinicians [11][12][13]. Despite acknowledgement of the importance of communication in medicine and considerable focus in this area over many decades [9], parental concerns about communication in EoL discussions for their child are recurring and persistent.…”