PC2048: Pediatric Medical Traumatic Stress in Chronic Illness: A Survey of Healthcare Provider Knowledge, Attitudes and Practices

Background: Patients with pediatric-onset chronic illnesses (PCIs) are at high risk for pediatric medical traumatic stress (PMTS), defined by the Child Traumatic Stress Network as “a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences.” The unique position of healthcare providers in shaping the patient experience has led to calls for a trauma-informed approach to medical care in pediatric healthcare networks and for interventions aimed specifically at PMTS mitigation. In this national study of providers who care for children with PCI, we aimed to 1) characterize the provider knowledge, attitudes, self-rated competencies, and practices around PMTS in PCI patients, and 2) assess provider resources for and perceived barriers to trauma-informed care implementation.

Methods: A convenience sample of United States PCI healthcare providers were recruited through national listservs and social media platforms to participate in an electronic survey. The survey was adapted from the Trauma-Informed Care Provider Survey Version 2.0 to reflect the population of interest. Additional questions were developed to assess attitudes, practices, and resources. The full survey underwent read-aloud testing and expert review to ensure readability and face validity.

Results: Preliminary results include 274 participants from across all US regions, representing general pediatricians and pediatric subspecialists in 14 fields. 97% agreed or strongly agreed that decreasing patient and family stress is part of their job (n=266); and 99% agreed or strongly agreed that PMTS may impact patient physical wellbeing (n=271). Within the preceding 6 months, 90% had cared for a PCI patient with suspected PMTS (n=247); 60% had changed medical care plans because of patient PMTS symptoms (n=162); and 71% had referred at least one PCI patient to a mental health provider for suspected PMTS (n=194). Nearly half of participants scored below 75% on the knowledge assessment (n=132, 48%). Self-reported competencies and barriers to providing trauma-informed care interventions are see in figures 1 and 2, respectively. Training on trauma-informed care was known to be available to 49% of participating providers (n=135). PMTS specific training was available to only 18% (n=50).

Conclusion: Participants overwhelmingly recognized PMTS symptoms in PCI patients, the impact of PMTS symptoms on medical care plans and patient wellbeing, and providers’ role in mitigating PMTS. However, PMTS knowledge scores were low and there were widespread deficiencies in key trauma-informed care competencies on self-evaluation. Barriers to providing trauma-informed care were prominent. Few had relevant training available. There is a critical, widespread need to expand healthcare worker knowledge of and access to targeted resources for PMTS mitigation in patients with PCIs.