Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit

A Pilot Study

Kelly N. Michelson, MD, MPH; Elizabeth Charleston, BS; Danica Y. Aniciete, MS; Lauren R. Sorce, PhD, RN, CPNP-AC/PC; Patricia Fragen, BA; Stephen D. Persell, MD, MPH; Jody D. Ciolino, PhD; Marla L. Clayman, PhD, MPH; Karen Rychlik, MS; Virginia A. Jones, MS; Pamela Spadino, BA; Marcelo Malakooti, MD; Melanie Brown, MD; Douglas White, MD, MAS

Disclosures

Am J Crit Care. 2020;29(4):271-282. 

In This Article

Abstract and Introduction

Abstract

Background: Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes.

Objective: To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families' and health care teams' perceptions of the intervention.

Methods: This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a "navigator," met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups.

Results: Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive.

Conclusions: The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.

Introduction

Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience[1,2] and patient outcomes, such as length of stay and ICU costs.[3–5] Health care team communication with caregivers of critically ill patients can contribute to or mitigate caregivers' psychological morbidity, including depression, anxiety, somatization, and anticipatory grief.[5–10] High-quality communication can result in decisions and care plans that meet the needs and honor the values of patients and their families.[1,5]

Previous research demonstrates inadequacies in communication between parents of PICU patients and PICU health care team members.[11–14] Parents describe absence of clinician-initiated discussions, poor access to clinicians, insufficient information exchange between parents and providers, and inadequate care coordination among providers.[12–14] Despite the need to improve PICU communication between health care teams and families, few studies have been conducted on PICU-specific communication interventions.

We developed a navigator-based communication intervention called PICU Supports.[15] Our long-term goal is to determine whether PICU Supports improves parent-reported outcomes. This pilot study was conducted to assess the feasibility of studying and implementing PICU Supports and examine family and health care team perceptions of the intervention.

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