Physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit

Children's Hospital of Michigan, Detroit, MI, USA.
Pediatric Critical Care Medicine (Impact Factor: 2.34). 03/2011; 12(2):e64-8. DOI: 10.1097/PCC.0b013e3181e89c3a
Source: PubMed


To investigate critical care physicians' experiences and perspectives regarding follow-up meetings with parents after a child's death in the pediatric intensive care unit. Parents of children who die in the pediatric intensive care unit often desire a follow-up meeting with the physicians who cared for their child.
Semistructured, audio-recorded telephone interviews.
Six clinical centers affiliated with the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
Seventy critical care physicians (i.e., attendings and fellows) practicing or training at a Child Health and Human Development Collaborative Pediatric Critical Care Research Network clinical center between February 1, 2008 and June 30, 2008.
Twenty-three (33%) physicians reported never participating in a follow-up meeting with bereaved parents; 22 (31%) participated in one to five meetings; and 25 (36%) participated in more than five meetings. Of those with prior experience, 44 (94%) met with parents at the hospital and 40 (85%) met within 3 months of the death. Meeting content included discussing autopsy, parent questions, hospital course, cause of death, genetic risk, bereavement services, and legal or administrative issues; providing emotional support; and receiving parent feedback. Forty (85%) physicians perceived the meetings to be beneficial to families, and 35 (74%) to physicians. Barriers included time and scheduling, family and physician unwillingness, distance and transportation, language and cultural issues, parent anger, and lack of a system for meeting initiation and planning.
Critical care physicians have a wide range of experience conducting follow-up meetings with bereaved parents. Although physicians perceive benefits to follow-up meetings, barriers exist that interfere with their implementation in clinical practice.

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Available from: Susan Eggly, Jun 22, 2015
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    • "Parents also wanted to reconnect with the physician and staff and to gain reassurance that everything possible had been done for the child. Findings from these studies also indicated that physicians were willing to conduct bereavement meetings, primarily because they felt the meetings would be beneficial to parents (Meert et al., 2011; Eggly et al., 2013). "
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    ABSTRACT: Parent-physician bereavement meetings may benefit parents by facilitating sense making, which is associated with healthy adjustment after a traumatic event. Prior research suggests a reciprocal relationship between sense making and positive emotions. We analyzed parents’ use of emotion words during bereavement meetings to better understand parents’ emotional reactions during the meeting and how their emotional reactions related to their appraisals of the meeting. Parents’ use of positive emotion words increased, suggesting the meetings help parents make sense of the death. Parents’ use of positive emotion words was negatively related to their own and/or their spouse’s appraisals of the meeting, suggesting that parents who have a positive emotional experience during the meeting may also have a short-term negative reaction. Language analysis can be an effective tool to understand individuals’ ongoing emotions and meaning making processes during interventions to reduce adverse consequences of a traumatic event, such as a child’s death.
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    ABSTRACT: To describe a framework to assist pediatric intensive care unit physicians in conducting follow-up meetings with parents after their child's death. Many childhood deaths occur in pediatric intensive care units. Parents of children who die in pediatric intensive care units often desire a follow-up meeting with the physician(s) who cared for their child. Prior research conducted by the Collaborative Pediatric Critical Care Research Network on the experiences and perspectives of bereaved parents and pediatric intensive care unit physicians regarding the desirability, content, and conditions of follow-up meetings. The framework includes suggestions for inviting families to follow-up meetings (i.e., developing an institutional system, invitation timing, and format); preparing for the meeting (i.e., assessing family preferences; determining location, attendees, and discussion topics; reviewing medical and psychosocial history); structure of the meeting (i.e., opening, closing, and developing a meeting agenda); communicating effectively during the meeting; and follow-up for both parents and physicians. This framework is based on the experience and perspectives of bereaved parents and pediatric intensive care unit physicians. Future research should be conducted to determine the extent to which physician-parent follow-up meetings provide a benefit to parents, families, physicians, and other healthcare providers participating in these encounters.
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    ABSTRACT: Aims and objectives.  To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. Background.  Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. Design.  Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. Methods.  Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. Results.  The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. Conclusions.  Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. Relevance to clinical practice.  Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work.
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