Improving Family Outcomes with a Communication Intervention in the Pediatric ICU

描述(由申请人提供)：在儿科ICU通过沟通干预改善家庭结局。该项目将评估将标准化的跨学科沟通干预整合到儿科重症监护病房(PICU)的效果。拟议的干预措施旨在支持孩子在PICU住7天或更长时间的家庭，并减少与这一经历相关的压力。干预组家庭将从入住PICU的第7天开始每周接受最多3次护理会议，由跨学科儿科姑息护理小组的成员提供便利，并由同一协调员每周至少进行3次后续访问，以使家庭了解其孩子的健康状况，并提供情感支持和信息资源。对照组家庭将在PICU接受常规护理。结果将在出院时和研究登记后90天进行评估。该项目将采用整群随机对照试验设计及定量和定性方法，以评估(1)沟通干预在减少研究登记后3个月创伤后应激障碍家庭症状和儿童出院时急性应激障碍方面的有效性；(2)干预措施在增加家庭对临床医生沟通的满意度和减少家庭对冲突的看法方面的效果；(3)干预措施在不影响死亡率的情况下缩短PICU住院时间和资源利用的有效性；(4)干预和对照组家庭和临床医生对ICU的经验，以及实施干预措施的障碍和促进者。 公共卫生相关性：儿科重症监护病房(PICU)是一种情绪激动的氛围，对患者和家人提出了巨大的要求，并可能在父母中引发急性应激和创伤后应激障碍的症状。减少危重儿童家庭的压力是非常重要的，因为他们必须保持资源储备，以应对子女过渡到家或在医院死亡后的任何需求。研究干预旨在为家庭提供额外的心理社会资源(即与临床团队的开放沟通，以及工具和情感支持)，以减轻PICU的压力，并将在成人ICU中进行的成功研究推广到儿科环境。

DESCRIPTION (provided by applicant): Improving family outcomes with a communication intervention in the pediatric ICU. This project will evaluate the effects of integrating a standardized interdisciplinary communication intervention into the pediatric intensive care unit (PICU). The proposed intervention is designed to support families when their child is in the PICU for 7 days or more and to reduce the stress associated with the experience. Intervention group families will receive up to 3 weekly care conferences beginning on day 7 of the PICU stay that will be facilitated by members of the interdisciplinary pediatric palliative care team and at least 3 follow-up visits per week by the same facilitator to keep families informed about their child's health status and offer emotional support and informational resources. Control group families will receive usual care in the PICU. Outcomes will be assessed at discharge from the PICU and 90 days after study enrollment. The project will use a cluster-randomized control trial design and quantitative and qualitative methods to evaluate (1) the efficacy of the communication intervention on reducing family symptoms of post-traumatic stress disorder 3 months after study enrollment and acute stress disorder at the time the child is discharged from the PICU; (2) the effect of the intervention on increasing family satisfaction with clinician communication and reducing family perceptions of conflict; (3) the efficacy of the intervention on reducing PICU length of stay and resource utilization without affecting mortality rates; and (4) the ICU experience for families in the intervention and control groups and clinicians, and barriers and facilitators to implementing the intervention. PUBLIC HEALTH RELEVANCE: The pediatric intensive care unit (PICU) is an emotionally-charged atmosphere that places significant demands on patients and families and can induce symptoms of acute stress and post-traumatic stress disorder amongst parents. Reducing stress in families of critically ill children is very important as they must maintain a reserve of resources to manage whatever demands will follow after their child transitions to home or dies in the hospital. The study intervention is designed to provide families with additional psychosocial resources (i.e., open communication with the clinical team, and instrumental and emotional support) to reduce the stress of the PICU and extends successful research done in adult ICUs to pediatric settings.