How Can Physician Communication Skills Training Improve Health Outcomes in Pediatric Intensive Care Units?
Statement of Problem
Patients admitted to Pediatric Intensive Care Units (PICUs), particularly at major academic centers, experience transitions of care between different physicians during their stay. For patients with longer stays, these transitions may occur every 3-7 days, raising ethical and utilization issues resulting from miscommunication, inconsistencies, lack of goal creation, and overall patient/family dissatisfaction. Although many institutions and units across the country have seen the emergence of a “primary” intensivist, the responsibilities of this role are unstandardized, and are largely unexplored in the fast-paced, typical high turnover of the PICU.
Families commonly attribute their negative experiences to:
- provider’s lack of empathy
- lack of genuine partnership with their child’s provider
- inadequate or incomplete information disclosure
- lack of trust in their provider
- poorly timed information
- availability of their providers
In contrast, physicians describe these barriers to more effective communication:
- discomfort with their emotions, along with those of patients and their families
- time constraints to address psychosocial, spirituality, and advance planning discussions
- difficulties in care coordination and in particular differences in communication methods between primary and subspecialty physicians
- lack of formal communication training
These barriers become more pronounced in the ICU, where physicians who provide care for seriously ill patients also face difficult conversations, especially surrounding end-of-life discussions.
Through previous qualitative work with intensivists and oncologists, we illuminated barriers to and potential facilitators of communication of bad news and quality of life conversations. We are further exploring these barriers and facilitators through two studies.
In one study, we are working with families, nurses, social workers and physicians to develop a series of tools, worksheets, and training videos to facilitate family meetings. Simultaneously, we are conducting focus groups to obtain feedback from these partners regarding the usefulness of printed resources and videos.
In a separate study, we are developing and implementing a Continuity Care Intensivist (CCI) program with communication training and increased intensivist staffing in the PICU. We will enroll patients admitted to the PICU longer than 7 days in a randomized controlled trial, during which we’ll investigate the impact of the intervention on physician skill acquisition, physician satisfaction with the training, parent satisfaction, patient length of stay, as well as multiple other patient outcomes.
We believe that developing provider-oriented interventions, tools to assist family meeting preparation, and more standardization across health systems will ensure efficient, clear, and compassionate communication between providers and families. Most importantly, we believe that training in these skills should become a standard component of medical education and should be widely available for all pediatric caregivers.
The data from these studies will be used to inform future projects including: 1) the implementation of hospital-wide skill building around preparing for and conducting family meetings with these tools at other institutions, and 2) determining the feasibility and importance of additional staffing for PICUs and potential wide spread implementation of a continuity care intensivist program.
The Children's Hospital of Philadelphia, PolicyLab. How Can Physician Communication Skills Training Improve Health Outcomes in Pediatric Intensive Care Units? [Online] Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].