Working with families of suddenly and critically ill children - Physician experiences

Objective: To describe physicians' experiences in attempting to provide opt imal care for families of children who suffer from sudden, acute life-threa tening conditions (SALTC). Design: To generate descriptive data in this exploratory study, we used qua litative methods including focus groups and in-depth interviews. Transcript s of focus groups and interviews were analyzed for content using standard p henomenologic analysis methods, which resulted in a participant-generated c onceptual model of optimal care for families of children with SALTC. Setting: The intensive care unit of an urban pediatric teaching hospital. Participants: Twenty-two pediatric intensive care unit physicians, includin g residents, fellows, and attendings. Intervention: None. Main Outcome Measures: Each participating physi- cian provided qualitative descriptions of experiences caring for families of children with SALTC. Results: Physicians identified 4 components of optimal care for families: ( 1) providing timely, accurate information about their child; (2) maintainin g privacy for confidential discussions and personal grieving, (3) giving ad equate emotional support; and (4) granting family members the right to hold and comfort their dying child. Physicians also described barriers to, and facilitators of this optimal care. Conclusions: Descriptive information provided in this exploratory study off ers a complex model of optimal family care. Issues that affect the quality of care to families include those related to the context of providing care in a large teaching hospital, as well as subtleties of communication betwee n parents and staff. Physicians' beliefs about optimal, care of families in the pediatric intensive care unit revealed implications for both practice and training in pediatrics.