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Abstract PD-037: TALKING TO FAMILIES WHEN DEATH BECOMES A LIKELY OUTCOME - A PILOT SIMULATION PROGRAMME TO IMPROVE END OF LIFE CONVERSATIONS DURING AND AROUND PICU ADMISSION

Sidgwick, P.1; du Pre, P.1; Skellett, S.1

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 41
doi: 10.1097/01.pcc.0000537439.06687.80
Poster Discussion Abstracts
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1Great Ormond Street Hospital, Paediatric Intensive Care Unit, London, United Kingdom

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Aims & Objectives:

End of life conversations form the basis of many complex communication scenarios in paediatric intensive care (PICU). These conversations are sometimes initiated late in the disease process. Anecdotal evidence is that many clinicians shy away from the subject matter for a wide variety of reasons. A multidisciplinary, one-day pilot simulation course to address this unmet need was designed by the PICU and palliative care teams for members of the multidisciplinary team (MDT) who admit to our PICU.

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Methods

The course was oversubscribed and candidates were evenly drawn from medical and senior nursing roles; specialties represented included PICU, immunology, bone marrow transplant, oncology, pulmonary hypertension and craniofacial surgery.

A range of clinically complex and personally challenging clinical scenarios were developed for use with experienced educational actors. These included:

Previously fit and well child post cerebrovascular accident with a deeply religious family

Child with end stage cancer whose parents had the option of an experimental treatment

Child with advanced pulmonary hypertension whose parents are angry about failure of treatment

Child with incurable malignancy with parents reluctant to ask for withdrawal of life sustaining treatment but who secretly wish it to be offered

A demonstration scenario was run by the faculty for all candidates and four simulations were run in groups of four. Simulation safety and debrief tools were utilised throughout

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Results

Feedback from the day was universally positive.

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Conclusions

There is significant need for this course. Plans are now under way to extend it to a wider cohort of the PICU MDT and run it on a regular basis.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies