PHYSICIANS' CONCEPTUALIZATION OF "CLOSURE" AS A BENEFIT OF PHYSICIAN-PARENT FOLLOW-UP MEETINGS AFTER A CHILD'S DEATH IN THE PEDIATRIC INTENSIVE CARE UNIT

Eggly S, Meert KL, Berger J, Zimmerman J, Anand KJS, Newth CJL, Harrison R, Carcillo J, Dean JM, Wilson DF, Nicholson C. Journal of Palliative Care. 2013;29(2):69-75.

This study was a secondary analysis of data collected by the Collaborative Pediatric Critical Care Research Network to explore physician's conceptualization of closure as a benefit of follow-up meetings with bereaved parents. Pediatric critical care attending physicians and fellows (n = 67) were interviewed and their interviews were transcribed verbatim.

The authors chose the use of the work "closure" as the unit of analysis. The frequency of use and the meaning of the word closure were examined. Physicians (n = 38) used the word closure at least once for a total of 86 times. Physicians indicated that closure was a process or trajectory rather than an achievable goal. They also indicated that parents and physicians could move toward closure by gaining a better understanding of the causes or circumstances of the death and by reconnecting with, or resolving relationships between parents and health care professionals.

The researchers also stated that future research should be done to determine if follow-up meetings reduce the negative effects of bereavement for parents and physicians.

PARENTAL INFLUENCE ON CLINICAL MANAGEMENT DURING NEONATAL INTENSIVE CARE: A SURVEY OF US NEONATOLOGISTS

Baily SM, Hendricks-Munoz KD, Mally P. The Journal of Maternal-Fetal & Neonatal Medicine. 2013;26(12)1239-1244.

This anonymous Web-based survey of neonatologists (n = 893) sought to determine which neonatologists discussed care decisions most frequently and the percentage of clinical influenced by those conversations with family-centered care (FCC).

Of the neonatologists who responded, 88% stated that they practice FCC. The researchers found that the topics most frequently discussed with parents were blood transfusions, steroids for lung disease, and patent ductus arteriosus surgery. The researchers found that these topics were discussed by more than 90% of the respondents. It was found that parents had the most influence on clinicians with regard to their child receiving a blood transfusion and steroids, with more than 70% of clinicians stating that their decisions were influenced by parental opinions.

The authors concluded that FCC appears to have an impact on neonatal intensive are unit clinical decision-making processes. Further research is needed in this area may provide how to best communicate with families and run effective efficient FCC rounds.