Challenges to code status discussions for pediatric patients

• DOI: 10.1371/journal.pone.0187375
• Publication Date: 2017-11-02T16:19:10Z
• Authors: Katherine E. Kruse; Jason Batten; Melissa L. Consta...; Saraswati Kache; David Magnus
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Science; Q; R; Medicine; Humans; Child; Cardiopulmonary Resuscitation; Research Article; 3. Good health

Objectives In the context of serious or life-limiting illness, pediatric patients and their families are faced with difficult decisions surrounding appropriate resuscitation efforts in event a cardiopulmonary arrest. Code status orders one way to inform end-of-life medical decision making. The objectives this study evaluate extent which providers have knowledge code options explore association provider role (1) options, (2) perception timing discussions, (3) family receptivity (4) comfort carrying out discussions. Design Nurses, trainees (residents fellows), attending physicians from units where discussions typically occur completed short survey questionnaire regarding perceptions Setting Single center, quaternary care children’s hospital. Measurements main results 203 nurses, 31 trainees, 29 4 high-acuity responded (N = 263, 90% response rate). Based on an objective measure, demonstrate poor understanding available only 22% able enumerate more than two four options. contrast, groups self-report high levels familiarity reporting significantly higher nurses (p 0.0125). Nurses show different discussion timing, majority (63.4%) perceiving as occurring “too late” “much too (55.6%) “about right” (p<0.0001). Attending report having do (p≤0.0001). perceive receptive (p<0.0001 p 0.0018, respectively). Conclusions Providers differ these These findings may reflect inherent differences among providers, but also discordant visions function potential source moral distress. Lack likely barriers quality communication