A randomized comparative trial to evaluate a PICU navigator-based parent support intervention

Kelly N. Michelson*, Joel Frader, Elizabeth Charleston, Karen Rychlik, Danica Y. Aniciete, Jody D. Ciolino, Lauren R. Sorce, Marla L. Clayman, Melanie Brown, Patricia Fragen, Marcelo Malakooti, Sabrina Derrington, Douglas White

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E617-E627
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • communication
  • decision-making
  • family support
  • navigator
  • pediatrics
  • post intensive care syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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