Navigating Time-Critical Decisions in Pediatric Critical Care: A Proactive Communication Guide for Cultivating Prognostic Awareness.

Abstract

<b><i>Background:</i></b> Clinical teams face many barriers to communicating with the parents/caregivers of patients experiencing an acute decline. Outside of these time-critical situations, clinicians often can iteratively assess and cultivate prognostic awareness of the patient and parents/caregivers and elicit values and goals over multiple conversations. However, in emergent circumstances, a modified approach to support prognostic awareness is necessary. <b><i>Methods:</i></b> We developed a clinical practice guideline for time-critical decision making through consensus with an interprofessional group. <b><i>Results:</i></b> Our proposed strategy starts with a concise statement naming the situation and urgent decision to be made, followed by an outline of the medical options with individualized clinical contextualization for the child and/or parents/caregivers. Finally, incorporating responses (verbal and nonverbal) from the parents/caregivers, recommendations for next steps are offered, with a check-in to ensure agreement with the recommendation(s). <b><i>Conclusion:</i></b> This framework is intended to supplement, not replace, existing guidelines for eliciting values and making medical recommendations in time-critical situations.