PROGNOSTIC CONVERSATIONS BETWEEN PARENTS AND PHYSICIANS IN THE PEDIATRIC INTENSIVE CARE UNIT

Background Up to 80% of pediatric intensive care unit (PICU) patients experience new morbidities upon discharge. Patients and families rely on clear communication to prepare for post-PICU morbidities. Methods Surveys were given at PICU discharge to parents and attending physicians of patients who developed multi -organ dysfunction within 24 hours of PICU admission and whose parents completed an initial survey 5 to 10 days after PICU admission. Participants were asked about prognostic conversations regarding PICU mortality; patient post-PICU physical, cognitive, and psychological morbidities; and par-ent post-PICU psychological morbidities. Parents also indi-cated whether they wanted more prognostic information. Results Forty-nine parents and 20 PICU attending physi-cians completed surveys for 49 patients. Thirty parent (61%) and 29 physician (59%) surveys reported participating in any prognostic conversations. Concordance between par-ents and physicians about prognostic conversations was slight (kappa = 0.19). Parent (n = 22; 45%) and physician (n = 23; 47%) surveys most commonly reported prognostic conver-sations about post-PICU physical morbidities. Parents less commonly reported conversations about post-PICU cogni-tive morbidities (n = 10; 20%). According to parents, bedside nurses and physicians provided most prognostic informa-tion; social workers (54%) most commonly discussed par-ent psychological morbidities. Twenty-six parents (53%) requested more prognostic information. Conclusions Most parents and physicians reported having prognostic conversations, primarily about post-PICU physi-cal morbidities. More than half of parents wanted more infor-mation about potential post-PICU morbidities. More research is needed to understand how and when medical profession-als should have prognostic conversations with parents. (American Journal of Critical Care. 2023;32:118-126)