Multiprofessional Clinician Perspectives on Communicating About Brain Death in Children.

Abstract

Communicating about death by neurologic criteria (DNC), or brain death, presents complex challenges for multiprofessional providers in pediatrics. The heterogeneity of state-level and institutional brain death policies drives variability in clinical practice patterns, complicating clear and consistent messaging about this nuanced domain. Interprofessional and provider-family communication in brain death cases has been identified as a critical target for interventions, but little is known about multiprofessional clinicians' experiences in communicating about pediatric brain death. To describe multiprofessional clinician perspectives on communicating about brain death in children. This qualitative study included semistructured interviews with physicians, nurses, and social workers at a quaternary children's hospital. We performed inductive coding followed by thematic analysis to identify themes pertaining to clinician approaches to communicating about pediatric brain death, barriers to communication, and strategies to address these challenges. Twenty-two pediatric clinicians (intensivists, neurologists, registered nurses, clinical social workers) participated. Physicians and nonphysicians describe distinct approaches to communicating about pediatric brain death. They identify emotional, cognitive, and relational barriers to communication, including moral distress, inconsistent messaging, prognostic uncertainty, tension between hope and reality, lack of trust, and discrepant values. Provider-generated strategies to address barriers include conducting early, honest conversations, employing consistent messaging, ensuring presence of stakeholders for key conversations, creating emotional distance, and conveying humanity. Despite widespread recognition of the importance of clear communication in discussions pertaining to brain death, clinicians identify critical barriers to effective communication. Proposed actionable strategies to circumvent barriers prioritize consistent messaging and a humanistic approach. This work informs future communication-based interventions aimed at improving end-of-life care for patients facing a diagnosis of DNC.