Physician Communication In Pediatric End-of-life Care: A Simulation Study


Physician Communication In Pediatric End-of-life Care: A Simulation Study


Bateman LB; Tofil NM; White ML; Dure LS; Clair JM; Needham BL


DOI: 10.1177/1049909115595022


American Journal Of Hospice And Palliative Medicine




Child; Communication; Critical Care/methods; Decision Making; Emergency Medicine/education; Female; Hospitals Pediatric/organization & Administration; Humans; Intensive Care Units Pediatric/organization & Administration; Internship And Residency/methods; Male; Patient Simulation; Pediatrics/education; Professional-family Relations; Terminal Care/psychology
End-of-life Communication; Pediatric End-of-life Care; Physician–parent Communication; Qualitative Methods; Simulation


The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life.
Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent.
Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely.
Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units.
The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care.


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Bateman LB; Tofil NM; White ML; Dure LS; Clair JM; Needham BL, “Physician Communication In Pediatric End-of-life Care: A Simulation Study,” Pediatric Palliative Care Library, accessed May 29, 2022,

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