Jennifer K Walter1, Douglas Hill2, William A Drust2, Amy Lisanti3, Aaron DeWitt4, Amanda Seelhorst4, Ma Luisa Hasiuk5, Robert Arnold6, Chris Feudtner7. 1. Pediatric Advanced Care Team (J.K.W., C.F.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA. Electronic address: Walterj1@chop.edu. 2. Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA. 3. Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA; Department of Family and Community Health (A.L.), University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. 4. Division of Cardiac Critical Care Medicine (A.D., A.S.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 5. Department of Patient and Family Services (M.L.H.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 6. Section of Palliative Care (R.A.), University of Pittsburgh School of Medicine, Palliative and Supportive Institute UMPC Health System, Pittsburgh, Pennsylvania, USA. 7. Pediatric Advanced Care Team (J.K.W., C.F.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Children's Hospital of Philadelphia Research Institute (J.K.W., D.H., W.A.D., A.L., C.F.), Philadelphia, Pennsylvania, USA.
Abstract
CONTEXT: Family meetings are encouraged in the pediatric cardiac intensive care unit (CICU) with the expectation of supporting parental shared decision-making (SDM). However, they often fall short of this goal. Additionally, interprofessional team and family meetings are dominated by input from physicians, under-utilizing the skillset of the full clinical team. OBJECTIVES: 1) To determine feasibility of a codesign process to optimize the preparation of the interprofessional team and parents for conducting SDM-oriented family meetings in the CICU, and 2) to describe the resulting elements of the intervention including new support documents for the team and family to prepare for the meeting, team member roles in the meeting, and optimization of communication skills. METHODS: Experience-based codesign was used with CICU clinicians and parents of children hospitalized in the CICU to develop an intervention at a single institution. Sessions were audio recorded and transcribed and analyzed using modified grounded theory. Participants were surveyed about their engagement in the codesign process to assess feasibility. RESULTS: Fifteen professionals and six parents enrolled in the codesign and endorsed engagement in the process and importance of the intervention elements. Participants identified the benefit of complementary parent and team preparation for family meetings noting five distinct types of meetings that occurred frequently. Documents, processes, and skills training were developed to improve interprofessional teamwork regarding shared decision making and support of parents in family meetings. CONCLUSION: A codesign of an intervention with clinicians and parents in the CICU is a feasible and resulted in an intervention with broad support among clinicians in the CICU.
CONTEXT: Family meetings are encouraged in the pediatric cardiac intensive care unit (CICU) with the expectation of supporting parental shared decision-making (SDM). However, they often fall short of this goal. Additionally, interprofessional team and family meetings are dominated by input from physicians, under-utilizing the skillset of the full clinical team. OBJECTIVES: 1) To determine feasibility of a codesign process to optimize the preparation of the interprofessional team and parents for conducting SDM-oriented family meetings in the CICU, and 2) to describe the resulting elements of the intervention including new support documents for the team and family to prepare for the meeting, team member roles in the meeting, and optimization of communication skills. METHODS: Experience-based codesign was used with CICU clinicians and parents of children hospitalized in the CICU to develop an intervention at a single institution. Sessions were audio recorded and transcribed and analyzed using modified grounded theory. Participants were surveyed about their engagement in the codesign process to assess feasibility. RESULTS: Fifteen professionals and six parents enrolled in the codesign and endorsed engagement in the process and importance of the intervention elements. Participants identified the benefit of complementary parent and team preparation for family meetings noting five distinct types of meetings that occurred frequently. Documents, processes, and skills training were developed to improve interprofessional teamwork regarding shared decision making and support of parents in family meetings. CONCLUSION: A codesign of an intervention with clinicians and parents in the CICU is a feasible and resulted in an intervention with broad support among clinicians in the CICU.
Authors: Stephen H Taplin; Sallie Weaver; Veronica Chollette; Lawrence B Marks; Andrew Jacobs; Gordon Schiff; Carrie T Stricker; Suanna S Bruinooge; Eduardo Salas Journal: J Oncol Pract Date: 2015-04-14 Impact factor: 3.840
Authors: Judy E Davidson; Rebecca A Aslakson; Ann C Long; Kathleen A Puntillo; Erin K Kross; Joanna Hart; Christopher E Cox; Hannah Wunsch; Mary A Wickline; Mark E Nunnally; Giora Netzer; Nancy Kentish-Barnes; Charles L Sprung; Christiane S Hartog; Maureen Coombs; Rik T Gerritsen; Ramona O Hopkins; Linda S Franck; Yoanna Skrobik; Alexander A Kon; Elizabeth A Scruth; Maurene A Harvey; Mithya Lewis-Newby; Douglas B White; Sandra M Swoboda; Colin R Cooke; Mitchell M Levy; Elie Azoulay; J Randall Curtis Journal: Crit Care Med Date: 2017-01 Impact factor: 7.598
Authors: Elizabeth D Blume; Emily Morell Balkin; Ranjit Aiyagari; Sonja Ziniel; Dorothy M Beke; Ravi Thiagarajan; Laura Taylor; Thomas Kulik; Kenneth Pituch; Joanne Wolfe Journal: Pediatr Crit Care Med Date: 2014-05 Impact factor: 3.624
Authors: Emily M Balkin; Joanne Wolfe; Sonja I Ziniel; Peter Lang; Ravi Thiagarajan; Shay Dillis; Francis Fynn-Thompson; Elizabeth D Blume Journal: J Palliat Med Date: 2014-12-10 Impact factor: 2.947
Authors: Emily Morell; Mary Katherine Miller; Minmin Lu; Kevin G Friedman; Roger E Breitbart; Jeffrey R Reichman; Julie McDermott; Lynn A Sleeper; Elizabeth D Blume Journal: J Am Heart Assoc Date: 2021-01-14 Impact factor: 5.501