406 - “Death Is Not a Dirty Word:” A Qualitative Study of Emergency Department Clinicians’ Communication Experiences When Caring for Patients With Life-Limiting Diagnoses
Pediatric Emergency Medicine Fellow Children's National Hospital Washington, District of Columbia, United States
Background: Pediatric patients with life-limiting diagnoses frequently seek care in the Pediatric Emergency Department (PED) during times of acute illness, and even at the end of life. While the population of patients with life-limiting diagnoses is heterogenous, it is well-established in the literature that pediatric patients with chronic conditions are likely to have multiple hospitalizations and PED visits in their last year of life, with many such children dying in the PED itself. As such, healthcare provider knowledge and expertise in communicating with families of these vulnerable children is essential to providing quality family-centered care. Objective: In this study, we aim to examine PED physician and nurse experiences with communication when caring for families and patients with life-limiting diagnoses. This study focuses on clinician experiences with eliciting values regarding life-sustaining therapies, and perceptions of the PED clinician's role in multidisciplinary end-of-life discussions with families. Design/Methods: Participants were recruited from a quaternary care center. Individual semi-structured interviews were conducted virtually via Zoom, with electronic audio recording and transcription. Recruitment continued until thematic saturation achieved. Thematic content analysis was performed on the transcripts using Dedoose software. Results: We interviewed 17 emergency department clinicians, including 10 physicians and 7 nurses. Thematic content analysis revealed several salient themes, including challenges around written documentation, concerns around the timing and appropriateness of end-of-life discussions in the emergency setting, and clinician moral distress around the possibility of patient suffering and medical futility at end of life.
Conclusion(s): Clinicians report various communication-related challenges to providing optimal care for families and patients with life-limiting diagnoses. Many study participants expressed a desire to improve their communication skills in these uniquely challenging situations. This is an area that is ripe for clinician educational development and would benefit from further study with the input of family preferences and experiences to develop best practices.
