O0432 Oct.5: 1:46pm - Bridging the gap: Qualitative interviews with pediatric non-physician healthcare team members regarding roles during communication of difficult news to patients and families

Background: Delivering difficult news to patients and families is an essential but challenging communication skill. Currently, little information exists regarding the role that non-physician team members play during disclosure of difficult news to families of pediatric patients.

Specific

Aim: We conducted qualitative interviews to examine the roles that non-physician healthcare team members play during the process of difficult news delivery to families, including before, during, and after disclosure.

Methods:
Design: We implemented a qualitative research study based in grounded theory.
Sample: We interviewed non-physician healthcare team members, including nurses, child life specialists, social workers, chaplains, and care coordinators from the pediatric and neonatal intensive care units (PICU, NICU), and the pediatric oncology ward and clinic at a university based children’s hospital.
Data Collection: We conducted and audio-recorded 19 in-person, semi-structured interviews. Throughout data collection, we open coded the interview transcripts using the constant comparison method to iteratively adapt our interview guide and develop our codebook.
Analysis and Outcomes: After writing our codebook, we re-coded all interviews to generate categories and then further distilled the categories into themes.

Results: 19 interviews were completed among team members in the PICU, NICU, and pediatric oncology. Non-physician team members reported two primary roles when families receive difficult news, that of being a support system and serving as a bridge for the patient and family.
This support took many forms, and occurred through comforting and concrete actions, human touch, creating a safe space and being a physical presence, personalizing the experience, and providing emotional support. Support was further provided through active listening, with curiosity and embracing the uncomfortable, and naming and reframing the situation. Non-physician healthcare team members additionally acted as bridges for the patient and family through numerous roles. They provided a link between the patient and family to the physicians as mediators and through a non-medical perspective, expertise in bedside knowledge, and as repositories of family memory and dynamics. They also connected them to their life outside of the hospital. Bridging also encompassed being a conduit of information for families through updates and by interpreting medical information. Further, they bridged the gap between family understanding and medical advice in their roles as advocates, by being a catalyst for difficult conversations and through amplifying the voices of patients and families to the medical team and to one another.

Conclusion: Pediatric non-physician team members supported patients and families receiving difficult news and bridged the gap in numerous ways between the family and others. The identification of the numerous roles of these team members will guide future inter-professional training for delivery of difficult news in pediatrics.