Prognostic and Goals-of-Care Communication in the PICU: A Systematic Review

Authors

Megan L. McSherry, Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.
Lauren Rissman, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Riley Mitchell, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD.
Sherlissa Ali-Thompson, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
Vanessa N. Madrigal, Division of Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC.
Katie Lobner, Welch Medical Library, Johns Hopkins University, Baltimore, MD.
Sapna R. Kudchadkar, Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD.

Document Type

Journal Article

Publication Date

9-7-2022

Journal

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

DOI

10.1097/PCC.0000000000003062

Abstract

OBJECTIVE: Admission to the PICU may result in substantial short- and long-term morbidity for survivors and their families. Engaging caregivers in discussion of prognosis is challenging for PICU clinicians. We sought to summarize the literature on prognostic, goals-of-care conversations (PGOCCs) in the PICU in order to establish current evidence-based practice, highlight knowledge gaps, and identify future directions. DATA SOURCES: PubMed (MEDLINE and PubMed Central), EMBASE, CINAHL, PsycINFO, and Scopus. STUDY SELECTION: We reviewed published articles (2001-2022) that examined six themes within PGOCC contextualized to the PICU: 1) caregiver perspectives, 2) clinician perspectives, 3) documentation patterns, 4) communication skills training for clinicians, 5) family conferences, and 6) prospective interventions to improve caregiver-clinician communication. DATA EXTRACTION: Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology. DATA SYNTHESIS: Of 1,420 publications screened, 65 met criteria for inclusion with several key themes identified. Parent and clinician perspectives highlighted the need for clear, timely, and empathetic prognostic communication. Communication skills training programs are evaluated by a participant's self-perceived improvement. Caregiver and clinician views on quality of family meetings may be discordant. Documentation of PGOCCs is inconsistent and most likely to occur shortly before death. Only two prospective interventions to improve caregiver-clinician communication in the PICU have been reported. The currently available studies reflect an overrepresentation of bereaved White, English-speaking caregivers of children with known chronic conditions. CONCLUSIONS: Future research should identify evidence-based communication practices that enhance caregiver-clinician PGOCC in the PICU and address: 1) caregiver and clinician perspectives of underserved and limited English proficiency populations, 2) inclusion of caregivers who are not physically present at the bedside, 3) standardized communication training programs with broader multidisciplinary staff inclusion, 4) improved design of patient and caregiver educational materials, 5) the development of pediatric decision aids, and 6) inclusion of long-term post-PICU outcomes as a measure for PGOCC interventions.

APA Citation

McSherry, Megan L.; Rissman, Lauren; Mitchell, Riley; Ali-Thompson, Sherlissa; Madrigal, Vanessa N.; Lobner, Katie; and Kudchadkar, Sapna R., "Prognostic and Goals-of-Care Communication in the PICU: A Systematic Review" (2022). GW Authored Works. Paper 1657.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1657

Department

Pediatrics