The Use of Family Conferences in the Pediatric Intensive Care Unit

Michelson, Kelly; Clayman, Marla L.; Haber-Barker, Natalie; Ryan, Claire; Rychlik, Karen; Emanuel, Linda L.; Frader, Joel

doi:10.1089/jpm.2013.0284

Cited by 38 publications

(35 citation statements)

References 23 publications

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“…n Communication and psychosocial support Family meetings Family meetings rarely occur. 5 Effective in aiding decision making. 58 An evidence-based structure for family conferences exists.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, it seems clear that these meetings are infrequently used, even for the sickest children. 5 In one study, meetings were focused on information exchange and future management. Conferences occurred predominantly for sicker patients, those with complex chronic conditions, and those with PPC consultation.…”

Section: Family Meetingsmentioning

confidence: 99%

“…Conferences occurred predominantly for sicker patients, those with complex chronic conditions, and those with PPC consultation. 5 Although many clinicians believe that the family meeting is key to the practice of palliative medicine, 6 there is minimal evidence regarding families' perception of such meetings.…”

Section: Family Meetingsmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Palliative Care: Current Evidence and Evidence Gaps

Miller¹,

Levy²,

Linebarger³

et al. 2015

The Journal of Pediatrics

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“…n Communication and psychosocial support Family meetings Family meetings rarely occur. 5 Effective in aiding decision making. 58 An evidence-based structure for family conferences exists.…”

Section: Discussionmentioning

confidence: 99%

Section: Family Meetingsmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Palliative Care: Current Evidence and Evidence Gaps

Miller¹,

Levy²,

Linebarger³

et al. 2015

The Journal of Pediatrics

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“…Little data exist by which to compare the observed frequency of these discussions with that of PICUs outside the CPCCRN. In a recent single-site study investigating the use and content of family conferences among 661 PICU admissions, 34 conferences with a documented discussion about LWLS were identified (9). Of these, 25 discussed “do-not-resuscitate” orders and 9 discussed withdrawal of life support.…”

Section: Discussionmentioning

confidence: 99%

Limiting and Withdrawing Life Support in the PICU

Keele

Meert

Berg

et al. 2016

Pediatric Critical Care Medicine

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Objectives Most deaths in U.S. PICUs occur after a decision has been made to limitation or withdrawal of life support. The objective of this study was to describe the clinical characteristics and outcomes of children whose families discussed limitation or withdrawal of life support with clinicians during their child’s PICU stay and to determine the factors associated with limitation or withdrawal of life support discussions. Design Secondary analysis of data prospectively collected from a random sample of children admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting Seven clinical sites affiliated with the Collaborative Pediatric Critical Care Research Network. Patients Ten thousand seventy-eight children less than 18 years old, admitted to a PICU, and not moribund at admission. Interventions None. Measurements and Main Results Families of 248 children (2.5%) discussed limitation or withdrawal of life support with clinicians. By using a multivariate logistic model, we found that PICU admission age less than 14 days, reduced functional status prior to hospital admission, primary diagnosis of cancer, recent catastrophic event, emergent PICU admission, greater physiologic instability, and government insurance were independently associated with higher likelihood of discussing limitation or withdrawal of life support. Black race, primary diagnosis of neurologic illness, and postoperative status were independently associated with lower likelihood of discussing limitation or withdrawal of life support. Clinical site was also independently associated with likelihood of limitation or withdrawal of life support discussions. One hundred seventy-three children (69.8%) whose families discussed limitation or withdrawal of life support died during their hospitalization; of these, 166 (96.0%) died in the PICU and 149 (86.1%) after limitation or withdrawal of life support was performed. Of those who survived, 40 children (53.4%) were discharged with severe or very severe functional abnormalities, and 15 (20%) with coma/vegetative state. Conclusions Clinical factors reflecting type and severity of illness, sociodemographics, and institutional practices may influence whether limitation or withdrawal of life support is discussed with families of PICU patients. Most children whose families discuss limitation or withdrawal of life support die during their PICU stay; survivors often have substantial disabilities.

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“…(49) Protocols for routine family conferences for adult ICU patients with a mortality risk greater than 25% have been shown to reduce ICU length of stay and resource utilization. (50) Randomized controlled trials in adult ICUs suggest that improving family-clinician communication in the ICU can dramatically reduce symptoms of anxiety, depression, and PTSD among family members.…”

Section: Picu Opportunities: Existing Needs and Potential Solutionsmentioning

confidence: 99%

Integrating Palliative Care Into the PICU

Boss

Nelson

Weissman

et al. 2014

Pediatric Critical Care Medicine

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Objective This review highlights the benefits that patients, families and clinicians can expect to realize when palliative care service is intentionally incorporated into the PICU, focusing on pain and symptom management, enhancing quality of life, communication and decision-making, length of stay and sites of care, and grief and bereavement. Data Sources MEDLINE Data Synthesis and Conclusions The American Academy of Pediatrics suggests that palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions.

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The Use of Family Conferences in the Pediatric Intensive Care Unit

Cited by 38 publications

References 23 publications

Pediatric Palliative Care: Current Evidence and Evidence Gaps

Pediatric Palliative Care: Current Evidence and Evidence Gaps

Limiting and Withdrawing Life Support in the PICU

Integrating Palliative Care Into the PICU

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