The Factors Associated with High-Quality Communication for Critically Ill Children

Communication with family members about prognosis and goals of care often occur close to death for patients in the pediatric intensive care unit.

Families want timely, honest information from health care providers when their child is in the hospital pediatric intensive care unit (PICU). American Academy of Pediatrics and the American College of Critical Care Medicine Task Force clinical guidelines recommend that providers share information on patient status, prognosis, and treatment options with family decision-makers within 24ā€“48 hours of admission to the PICU.

These researchers analyzed 645 PICU admissions with a high risk of mortality for children at the University of Michigan Childrenā€™s Hospital (2004ā€“2010) to determine the feasibility of following this recommendation and whether communication varied by patient characteristics, disease diagnosis, provider type, or proximity to dying.

On average, 31 percent of patients had documentation of a prognostic, goals-of-care conversation (PGOCC) in their medical record, a percentage that was unaffected by sex, age, or disease category.

Oncology patients (53%) and those who died in the PICU (94%) were more likely to have a documented PGOCC than others. Patients witch cancer, a diagnosis strongly associated with mortality, had a PGOCC earlier in their stay than other patients.

Even though conversations about prognosis and care goals help family decision-makers, too often for providers, documentation of PGOCC is strongly connected to end-of-life care.