A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention

Title

A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention

Creator

Michelson KN; Frader J; Charleston E; Rychlik K; Aniciete DY; Ciolino JD; Sorce LR; Clayman ML; Brown M; Fragen P; Malakooti M; Derrington S; White D

Publisher

Pediatric Critical Care Medicine

Date

2020

Subject

Child; Humans; Communication; Parents; Personal Satisfaction; Intensive Care Units Pediatric; Terminal Care

Description

OBJECTIVES: Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. DESIGN: Patient-level, randomized trial. SETTING: Two university-based, tertiary-care children's hospital PICUs. PARTICIPANTS: Parents of patients requiring more than 24 hours in the PICU. INTERVENTIONS: PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. MEASUREMENTS AND MAIN RESULTS: The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. CONCLUSIONS: Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.

Rights

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Citation List Month

March 2021 List

Collection

Citation

Michelson KN; Frader J; Charleston E; Rychlik K; Aniciete DY; Ciolino JD; Sorce LR; Clayman ML; Brown M; Fragen P; Malakooti M; Derrington S; White D, “A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention,” Pediatric Palliative Care Library, accessed September 22, 2021, https://pedpalascnetlibrary.omeka.net/items/show/17483.

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