Pediatric Chronic Critical Illness: Training Teams to Address the Communication Challenges of Patients With Repeated and Prolonged Hospitalizations

J Pain Symptom Manage. 2020 Jun 12;S0885-3924(20)30437-1. doi: 10.1016/j.jpainsymman.2020.06.005. Online ahead of print.

Abstract

Context: Children with chronic critical illness (CCI) have repeated and prolonged hospitalizations. Discrete communication challenges characterize their inpatient care.

Objectives: Develop, implement and evaluate a communication training for inpatient clinicians managing pediatric CCI.

Methods: A one-day communication training for interdisciplinary clinicians, incorporating didactic sessions and simulated family and interdisciplinary team meetings.

Results: Learners had an average of 11 years' clinical experience. 34% lacked prior communication training relevant to pediatric CCI. Mean baseline competence across communication skills was 2.6 (range 2.4-3.2), corresponding to less than "somewhat prepared"; after the training this increased to a mean of 4.0 (range 3.5-4.5), corresponding to "well prepared." Skills with greatest improvement included conducting a family meeting, delivering bad news, discussing stopping intensive care, and end of life communication. After 1 month, perceived competence was sustained for 7/10 skills; for remaining skills, perceived competence scores decreased by 0.1-0.2. 100% of learners would recommend the training to colleagues; 89% advocated it for all clinicians caring for children with CCI.

Conclusion: Interdisciplinary communication training regarding long stay patients is feasible and valued by novice and seasoned clinicians. The novel integration of intra-team communication skills alongside team-family skills reflects the reality that the care of children with CCI challenges clinicians to communicate well with each other and with families. Teaching interdisciplinary teams to share communication skills has the potential to overcome reported limitations of existing inpatient discussions, which can be dominated by one or two physicians and lack contributions from diverse team members.

Keywords: Chronic critical illness; Communication; medical education.