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JOURNAL ARTICLE

Feasibility and perceived benefits of a framework for physician-parent follow-up meetings after a child's death in the PICU

Kathleen L Meert, Susan Eggly, Robert A Berg, David L Wessel, Christopher J L Newth, Thomas P Shanley, Rick Harrison, Heidi Dalton, Amy E Clark, J Michael Dean, Allan Doctor, Carol E Nicholson
Critical Care Medicine 2014, 42 (1): 148-57
24105453

OBJECTIVE: To evaluate the feasibility and perceived benefits of conducting physician-parent follow-up meetings after a child's death in the PICU according to a framework developed by the Collaborative Pediatric Critical Care Research Network.

DESIGN: Prospective observational study.

SETTING: Seven Collaborative Pediatric Critical Care Research Network-affiliated children's hospitals.

SUBJECTS: Critical care attending physicians, bereaved parents, and meeting guests (i.e., parent support persons, other health professionals).

INTERVENTIONS: Physician-parent follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework.

MEASUREMENTS AND MAIN RESULTS: Forty-six critical care physicians were trained to conduct follow-up meetings using the framework. All meetings were video recorded. Videos were evaluated for the presence or absence of physician behaviors consistent with the framework. Present behaviors were evaluated for performance quality using a 5-point scale (1 = low, 5 = high). Participants completed meeting evaluation surveys. Parents of 194 deceased children were mailed an invitation to a follow-up meeting. Of these, one or both parents from 39 families (20%) agreed to participate, 80 (41%) refused, and 75 (39%) could not be contacted. Of 39 who initially agreed, three meetings were canceled due to conflicting schedules. Thirty-six meetings were conducted including 54 bereaved parents, 17 parent support persons, 23 critical care physicians, and 47 other health professionals. Physician adherence to the framework was high; 79% of behaviors consistent with the framework were rated as present with a quality score of 4.3 ± 0.2. Of 50 evaluation surveys completed by parents, 46 (92%) agreed or strongly agreed the meeting was helpful to them and 40 (89%) to others they brought with them. Of 36 evaluation surveys completed by critical care physicians (i.e., one per meeting), 33 (92%) agreed or strongly agreed the meeting was beneficial to parents and 31 (89%) to them.

CONCLUSIONS: Follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework are feasible and viewed as beneficial by meeting participants. Future research should evaluate the effects of follow-up meetings on bereaved parents' health outcomes.

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