37 Content analysis of serious illness conversations in an Australian paediatric intensive care unit

<h3>Objective</h3> Quality communication between clinicians and parents in paediatric intensive care improves shared decision making by fostering trust, reducing parental distress and improving parental comprehension of the child’s illness. This study aims to review the thematic content of conversations between parents and clinicians in the paediatric intensive care unit. <h3>Design</h3> Prospective observational study. <h3>Setting</h3> A tertiary Australian paediatric intensive care unit. <h3>Participants</h3> Parents/carers/families and health care staff (paediatric intensive care doctors, nursing staff, social workers and other specialist doctors) involved in care of children admitted to the paediatric intensive care unit. <h3>Main Outcome Measures</h3> Content analysis was used to classify conversational content in parent-clinician interactions. Initial content categories were derived from an existing guide for serious illness conversations. The duration of time spent discussing content in each category was expressed as a percentage of the meeting duration. General observations of the content and structure of the meeting were also summarised. <h3>Results</h3> Five family meetings were video-recorded. Content categories consistent with an existing guide for serious illness conversations included a conversation introduction (mean duration 3.58% [SD 1.15%]), assessment of parental understanding (mean duration 5.72% [SD 2.59%]), provision of a medical update (mean duration 57.35%, [SD 18.84%]), assessment and alignment of parental support systems (mean duration 21.95%, [SD 13.52%]) and closure of the meeting (mean duration 6.86%, [SD 1.52%]). None of the conversations addressed exploring important abilities (physical or cognitive) or values specific to the child. Additional content categories that were identified and not part of the existing guide accounted for 4.50% [SD 4.64%] of the meeting duration. This included addressing uncertainty surrounding the child’s illness, fostering hope, and addressing legal/systemic issues. <h3>Conclusions</h3> This study provides valuable insights into the day-to-day dynamics of parent-clinician conversations in PICU. The content shares similarities with an existing guide for serious illness conversations. Our findings also highlight a number of nuances to communication in the PICU including the importance of addressing uncertainty and hope in these conversations. <h3>Unique Contribution</h3> Use of conversation in terms of ACP and Serious Illness conversation. Paediatric perspective Paediatric intensive care perspetive.