Decision making and satisfaction with care in the pediatric intensive care unit: findings from a controlled clinical trial

Abstract

Objective: To facilitate critical decision making and improve satisfaction with care among families of patients in a pediatric intensive care unit.

Design: Prospective observational study followed by a nonrandomized controlled trial of a clinical intervention to identify conflicts and facilitate communication between families and the clinical team.

Setting: The pediatric intensive care unit of a Boston teaching hospital.

Patients: A total of 127 patients receiving care in the pediatric intensive care unit in 1998-1999 and their families.

Interventions: Interviews were conducted with surrogates and decisionally capable older children concerning the adequacy of information provided, understanding, communication, and perceived decisional conflicts. Findings were relayed to the clinical team, who then developed tailored follow-up recommendations.

Measurements and main results: A survey administered to surrogates at baseline and day 7 or intensive care unit discharge measured satisfaction with care. Information on patient acuity and hospital stay were extracted from medical records and hospital databases. Wilcoxon rank-sum tests and incidence rate comparisons were used to assess the impact of the intervention on satisfaction and sentinel decision making, respectively. Incidence rates of care plan decision making, including decisions to adopt a comfort-care-only plan and decisions to forego resuscitation, were lower among families who received the intervention. The intervention did not significantly affect satisfaction with care.

Conclusions: Prospectively screening for and intervening to mitigate potential conflict did not increase decision making or parental satisfaction with the care provided in this pediatric intensive care unit.