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Design and Participants: This trial (at a large urban pediatric hospital with 32 dedicated CICU beds) implemented a family- and team-support intervention for conducting family meetings and conducted a pretest-posttest study with parents of patients selected for meetings and clinicians. Questionnaires and semi-structured interviews measured feasibility, fidelity to intervention protocol, and parent acceptability. Semantic content analyses of transcripts (tracking parental concern elicitation, questions asked of parents, and responses to parental empathic opportunities) assessed clinician behavior in meetings. Logistic and ordinal logistic regression assessed intervention impact on clinician communication behaviors in meetings comparing pre- and post-intervention data.
Results: Sixty parents were enrolled (95% of approached; n=30 pre-intervention, n=30 post; 68% mothers; 58% White, 77% non-Hispanic). In all, 98% of parent questionnaire data and 97% of meeting data were collected. Eighty percent of patients were younger than 6-months old, 60% were White, and 30% had a syndromic diagnosis. Meetings were conducted on CICU day of admission 35 (SD=30) in pre-intervention and 40 (SD=41) of post-intervention. More than 85% fidelity was accomplished. There was a mean of 4 clinicians in pre-intervention (range=1-7) and post-intervention (2-6) meetings. Most parents (80%) said the preparation worksheet had the right amount of information and felt positive about receiving this worksheet; 96% found the summary sheet helpful and understandable. Clinicians were more likely to elicit parental concerns (adjusted odds ratio=3.4; 95% CI=1.1-11]) in postintervention meetings. There were no differences in remaining measures.
Commentary: In a single-center pilot study to enhance family meetings in the pediatric CICU, investigators found that the CICU Teams and Loved Ones Communicating (CICU-TALC) intervention was feasible to implement in an acute care setting; welcomed by families as a means of increasing agency and preparation for difficult conversations; and spurred clinician behavior change. As family meetings often provoke tension in families of children with serious illness, CICU-TALC provides a model for engaging the interdisciplinary team in preparing families for high-stakes discussions, without prolonging meeting duration. The intervention also integrates clinician communication skills training, which may confer lasting benefits. CICU-TALC should be translated to other acute care settings and with other populations of children with serious illness to augment overall yield of and satisfaction with family meetings.
Bottom Line: An intervention to enhance parent and clinician preparation for family meetings in the pediatric CICU is acceptable, feasible, and may improve clinician behaviors. Similar interventions should be implemented in other acute care settings as a means of improving parent and clinician satisfaction with family meetings.
Reviewer: Prasanna Ananth, MD MPH, Yale School of Medicine, New Haven, CT
References:
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Source: Walter J, Hill DL, Cetin A, et al. A pediatric interprofessional cardiac intensive care unit intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is feasible, acceptable, and improves clinician communication behaviors in family meetings [online ahead of print May 3, 2024]. Pediatr Cardiol. doi:10.1007/s00246-024-03497-7.
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