Critical Care Fellows’ Perceptions of Parent Distress in the Pediatric Intensive Care Unit

Background/Purpose. During hospitalization in the pediatric intensive care unit (PICU), approximately 25-60% of parents experience clinical levels of distress (i.e., traumatic stress, anxiety, and depressed mood), which likely impacts their decision-making, ability to care for their child, and puts them at risk for long-term psychological sequelae (e.g., posttraumatic stress disorder). Despite this, PICU providers rarely refer parents to formal psychological services, and parents report that their emotional needs are not well addressed by hospital staff. Difficulty identify and/or responding to distressed parents may explain these deficiencies. Therefore, the present study aimed to evaluate how fellows identify and respond to parent distress in the PICU. Fellowship trainees in Pediatric Critical Care Medicine are only beginning to develop practice habits and thus can provide insight into this skill acquisition. Methods. Twelve PICU fellows (50% female, 58% White) completed a semi-structured interview and answered five questions on a 4-point Likert scale, ranging from Not at all to Very, about experiences with distressed parents. The Delphi method was used to code qualitative data. Results. Fellows reported that it is equally the role of the PICU medical team and psychosocial providers (n=10), or primarily the medical teams’ role (n=2), to directly work with parents to manage distress. They reported that it is very (n=10) or moderately (n=2) important to be able to support distressed parents. Fellows were moderately (n=9) or slightly (n=3) confident in their ability to support distressed parents. Parent anger (n=9), sadness (n=7), and disengagement (n=7) were the most frequently reported indicators of distress. Participants described child medical acuity (n=10) and/or severity (n=6), parent medical understanding (n=8), and external factors (e.g., caring for other children; n=6) as contributing to distress. Being present, explaining medical information, and connecting parents to resources were the most frequently reported strategies for supporting distressed parents (Table 1). Fellows reported their strategies to be moderately (n=11) to very (n=1) helpful to parents. Provider time, availability of resources, and language barriers were most frequently reported as challenges to supporting distressed parents (Table 2). Participants were very (n=7), moderately (n=3), and slightly (n=2) interested in receiving training on how to support distressed parents. Conclusion. All fellows felt that it is important and at least partially the medical team’s responsibility to manage parent distress in the PICU. They identified parent medical understanding and child medical factors as risk factors. Being present, explaining medical information, and utilizing external resources were important strategies for responding to distress. Most were very interested in receiving training to better support parents. Educational interventions targeting these areas should be developed and tested to overcome barriers of provider time, resource availability, and language.