Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital

Kimberly E Sawyer; Alana T Carpenter; Ryan D Coleman; Sebastian C Tume; Claire A Crawford; Jessica A Casas

doi:10.1016/j.jpainsymman.2022.05.009

Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital

J Pain Symptom Manage. 2022 Sep;64(3):e115-e121. doi: 10.1016/j.jpainsymman.2022.05.009. Epub 2022 May 23.

Authors

Kimberly E Sawyer¹, Alana T Carpenter², Ryan D Coleman³, Sebastian C Tume³, Claire A Crawford⁴, Jessica A Casas⁵

Affiliations

¹ St. Jude Children's Research Hospital (K.E.S.), Memphis, Tennessee, USA.
² The Woman's Hospital of Texas (A.T.C.), Houston, Texas, USA.
³ Baylor College of Medicine (R.D.C., S.C.T., J.A.C.), Houston, Texas, USA.
⁴ Texas Children's Hospital (C.A.C.), Houston, Texas, USA.
⁵ Baylor College of Medicine (R.D.C., S.C.T., J.A.C.), Houston, Texas, USA. Electronic address: jxcasas@texaschildrens.org.

PMID: 35613688
DOI: 10.1016/j.jpainsymman.2022.05.009

Abstract

Context: More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST process in pediatrics.

Objectives: This study aims to describe interdisciplinary provider self-reported confidence, needs, and suggestions for improving the WOLST process.

Methods: A convergent parallel mixed-methods design was used. An online survey was distributed to providers involved in WOLSTs in a quaternary children's hospital between January and December 2018. The survey assessed providers' self-reported confidence in their role, in providing guidance to families about the WOLST, experiences with the WOLST process, areas for improvement, and symptom management. Kruskal-Wallis testing was used for quantitative data analysis with P values <0.05 considered significant. Analysis was performed with SPSS v27. Qualitative data were thematically analyzed using Atlas.ti.8 and NVivo.

Results: A total of 297 surveys were received (48% survey completion) that consisted of multiple choice, Likert-type, and yes/no questions with options for open-ended responses. Mean provider self-rated confidence was high and varied significantly between disciplines. Qualitative analysis identified four areas for refining communication: 1) between the primary team and family, 2) within the primary team, 3) between the primary team and consulting providers, and 4) logistical challenges.

Conclusions: While participants' self-rated confidence was high, it varied between disciplines. Participants identified opportunities for improved communication and planning before a WOLST. Future work includes development and implementation of a best practice guideline to address gaps and standardize care delivery.

Keywords: Withdrawal of life-sustaining therapies; cardiovascular intensive care unit; neonatal intensive care unit; palliative care; pediatric intensive care unit; pediatrics.

MeSH terms

Child
Communication
Hospitals, Pediatric*
Humans
Intensive Care Units
Palliative Care* / methods
Surveys and Questionnaires