Assistant Professor, Neonatology and Bioethics Children's Research Institute, Children's Mercy Hospital Kansas City, Missouri, United States
Background: The incidence of tracheostomy placement with mechanical ventilation dependence is increasing for children with chronic critical illness. While there are clinical scenarios where tracheostomy placement is clearly medically indicated (e.g., isolated airway obstruction in the setting of curable disease) or medically inappropriate (e.g., multiorgan failure in a patient with untreatable, terminal malignancy), the practice of shared decision-making in tracheostomy (SDMiT) is indicated when prognosis is uncertain and quality of life is paramount. Prior surveys of parents and medical providers demonstrate multiple areas for improvement surrounding SDMiT. Objective: To improve education about SDMiT through the development and implementation of an online learning module for medical team members who participate in family/team discussions about tracheostomy. Design/Methods: A multidisciplinary team developed a 30-minute online learning module that defined SDMiT and included examples of parent, clinician, and shared decisions; a 17-minute video of parents discussing their decision-making process; examples of appropriate language to elicit hopes, values, and worries from families facing a decision regarding tracheostomy for their child; and a brief quiz to confirm participant understanding of different types of clinical decisions (parent, clinician, shared). The module was evaluated through an optional post-module survey. Results: 452 participants completed the online learning module (physicians, advance practice providers, nurses, and respiratory therapists); 104 completed the optional post-module survey (response rate 23%). 80% of respondents (n=78/97) agreed or strongly agreed that they learned new knowledge regarding SDMiT; 85% (n=82/96) noted improvement in skills in approaching conversations surrounding this topic; and 60% (n=57/95) stated it would change their clinical practice. 94% (n=90/96) of respondents would recommend this course to a colleague and 77% (n=72/93) would like more education about shared decision-making principles in general.
Conclusion(s): An online learning module is a promising method of teaching medical team members the principles of SDMiT and may be a useful tool in standardizing and teaching communication skills in shared decision-making more broadly. Further work is needed to measure the impact of this educational module on communication skills over time.
