Communication Strategies & Palliative Care in the PICU--Part 2
Sep 19, 2022
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This podcast explores communication strategies and palliative care in the PICU. Topics include the R-E-M-A-P framework for discussing difficult medical situations, using nurse statements to build rapport, developing communication skills in the ICU, and navigating difficult scenarios in palliative care.
25:11
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Quick takeaways
The vital talk curriculum, based on the REMAP acronym, provides a framework for difficult conversations in palliative care, helping healthcare providers reframe the situation, expect and respond to emotions, map out values, align with the family's goals, and create a plan.
Understanding and respecting the values of families is crucial in navigating difficult scenarios where families insist on 'everything done' for their seriously ill child, and healthcare providers should focus on providing clarity and avoiding cognitive overload to enable informed decision-making.
Deep dives
Practical Tips for Having Difficult Conversations with Families
In this episode, Dr. Stockton Beverage and Dr. Katie Maddox provide practical tips for having difficult conversations with families in the ICU. They emphasize the importance of communication skills in palliative care and highlight the vital talk curriculum as a framework for these conversations. The vital talk curriculum, based on the acronym REMAP, guides healthcare providers to reframe the situation, expect and respond to emotions, map out values, align with the family's goals, and finally, create a plan. They emphasize the need for concise and clear headlines when delivering information to families, ensuring both the information and its meaning are conveyed. Additionally, the importance of empathetic nurse statements is highlighted to validate and respond to the emotions expressed by the families.
Navigating Difficult Scenarios with Families Insisting on 'Everything Done'
Dr. Beverage and Dr. Maddox share their approach to conversations with families who insist on 'everything done' for their seriously ill child, even if the chance of improvement is minimal. They discourage the use of the phrase 'everything done' as it can lead to misunderstandings, instead recommending a thorough mapping of the family's values. By understanding what is most important to the family and aligning recommendations with those values, healthcare providers can navigate these difficult scenarios. They emphasize the importance of humility and recognizing that families are the ones making decisions for their loved ones. The conversation should focus on providing clarity and avoiding cognitive overload for families, ensuring they understand the potential outcomes and allowing them to make informed decisions that align with their values.
Continued Learning and Growth in Communication Skills
Dr. Beverage and Dr. Maddox encourage learners to continue developing their communication skills even after fellowship training. They suggest practicing skills informally during family meetings or in everyday interactions, as well as seeking opportunities to lead conversations and have experienced professionals observe and provide feedback. The importance of exposure and learning from experts in the field is emphasized, while also encouraging learners to find their own authentic style within the framework of effective communication. They underscore the value of empathy and recognizing the profundity of the parent-child relationship in the ICU, acknowledging the privilege of being involved in such critical and sacred moments of care.
Stockton Beveridge, M.D., is an Assistant Professor in the Department of Pediatrics in the Division of Developmental / Behavioral Pediatrics, serving as the director of Pediatric Palliative Care. Dr. Beveridge’s research interests have focused on the challenges faced by caregivers of children with medical complexity, particularly in the Latino population. He is additionally interested in the intersection of religion and medicine, particularly in medical crisis. He sits on the hospital’s Ethics Committee and is also the medical director for Schwartz Rounds.
Katie Maddox, M.D., is an Assistant Professor in the Department of Pediatrics in the Division of Developmental / Behavioral Pediatrics at UT Southwestern. She is a board-certified pediatric palliative care physician at Children’s Health Dallas. Her clinical and research interests relate to caring for children with special healthcare needs and communication skills training in medical education. Dr. Maddox has received the Educational Innovation Award for developing communication skills training and the Pediatric Society of Greater Dallas White Hat Award.
By the end of this two-part series, listeners will be able to:
Verbalize a more progressive definition of palliative care, and distinguish it from "end-of-life" care or hospice care.
Define appropriate patient populations for referral to palliative care.
Sensitively and clearly introduce palliative care referral with patients and families.
Recognize the value of communication training, and verbalize a simple framework for difficult conversations.
Define the challenges of learning/practicing difficult communication as a resident/fellow, and elaborate some strategies to help mitigate these challenges.
References:
Center to Advance Palliative Care--https://www.capc.org/
Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: A Framework for Goals of Care Conversations. J Oncol Pract. 2017 Oct;13(10):e844-e850. doi: 10.1200/JOP.2016.018796. Epub 2017 Apr 26. PMID: 28445100.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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