PC3056: Acceptability of Qualitative Text-based Assessment of Parent Coping in the Pediatric Intensive Care Unit

Background: Hospitalization in the pediatric intensive care unit (PICU) is a stressful situation for children and families, with adverse effects frequently persisting post-discharge. Following the hospitalization of a critically ill child, 84% of parents report symptoms of traumatic stress and 21% meet criteria for post-traumatic stress disorder. Parents’ subjective experiences, more than objective illness severity, predict adverse mental health outcomes. Therefore, understanding real-time experiences may provide an opportunity to improve parents’ mental health. While real-time surveys have been well-received in other settings, the acceptability and feasibility of such methods in the intensive care setting is not known. This pilot study explored parents’ experiences with a text-message-based interface to identify and track the experiences of PICU parents.

Methods: Following admission to the PICU, parents were identified and enrolled based on expected length-of-stay >48 hours. Throughout their stay, parents received prompts every other day, which included an optional, open-ended question assessing stress and coping. Following discharge, they responded to this question at 1 week, 1 month, 3 months, and 6 months. Qualitative interviews were conducted at 1 week and 3 months post discharge to assess the acceptability of the optional text-based qualitative question about stress and coping. Parents were compensated for participating.

Results: Fourteen participants enrolled and completed the study utilizing the text-message-based interface. Overall participants provided responses to 20% of the open-ended prompts with 43% (n=6) of participants answering at least one open ended response. Of those who used it once, most (83%) used this option more than once. The most common free-text themes were medical status of the patient, negative emotions, and faith (Table 1). Following completion, 11 participants completed a qualitative interview regarding the use of open-ended questions as part of the text-message-based interface. Parents reported the free texting was therapeutic and allowed for elaboration (Table 2).

Conclusion: Admission to the PICU is often a source of traumatic stress on patients and families and impacts their wellbeing after discharge. Parents were given the opportunity to share the emotional toll and coping strategies they used both during their PICU stay and following discharge. Nearly half of the participants utilized the free-text option to elaborate on their stress and coping during and after admission, and most of those utilized the option more than once. Parents most frequently reported that the medical status of their child contributed to their stress and described negative emotions associated with their stay in the PICU. Parents also discussed several protective factors including faith, activity, and support systems as means of coping. Many of the participants who utilized the free-text option stated they found it helpful to reflect on their experience, indicating that it’s an important option for some families to process the traumatic stress associated with PICU admission.