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Feasibility and Perceived Benefits of a Framework for Physician-Parent Follow-Up Meetings After a Child’s Death in the PICU*

Meert, Kathleen L. MD1; Eggly, Susan PhD2; Berg, Robert A. MD3; Wessel, David L. MD4; Newth, Christopher J. L. MD5; Shanley, Thomas P. MD6; Harrison, Rick MD7; Dalton, Heidi MD8; Clark, Amy E. MS9; Dean, J. Michael MD9; Doctor, Allan MD10; Nicholson, Carol E. MD11

doi: 10.1097/CCM.0b013e3182a26ff3
Pediatric Critical Care

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.

1Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

2Department of Oncology, Karmanos Cancer Institute, Detroit, MI.

3Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

4Department of Pediatrics, Children’s National Medical Center, Washington, DC.

5Department of Anesthesiology and Critical Care, Children’s Hospital Los Angeles, Los Angeles, CA.

6Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, Ann Arbor, MI.

7Department of Child Health, Mattel Children’s Hospital at University of California Los Angeles, Los Angeles, CA.

8Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ.

9Department of Pediatrics, University of Utah, Salt Lake City, UT.

10Departments of Pediatrics and Biochemistry, St. Louis Children’s Hospital, St. Louis, MO.

11National Institute of Child Health and Human Development, Bethesda, MD.

* See also p. 214.

Supported, in part, by grants U10HD050096, U10HD049981, U10HD063108, U10HD063106, U10HD063114, U10HD050012, and U01HD049934 in cooperative agreements from the National Institute of Child Health and Human Developmentand the Department of Health and Human Services.

Dr. Meert has received grant support and travel reimbursements from the National Institutes of Health (NIH). Dr. Berg’s institution has received a NICHD grant as a site PI for the Collaborative Pediatric Critical Care Research Network. Drs. Eggly, Wessel, Dalton, Clark, and Dean receive support from the National Institutes of Health (NIH). Dr. Newth is supported by a grant from NICHD, U10 (Collaborative Pediatric Critical Care Research Network). Dr. Shanley received grant support from the NIH; is a board member for EAB Univ Cinci; and provides expert testimony to Lawson-Wilson; receives payment for lectures from Advances in Neonatology; and receives royalties from Springer. Dr. Harrison has received grant support from the NIH and payment for lectures and travel/accommodations from SCCM. Drs. Doctor and Nicholson disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins