More than 74% of juvenile fatalities occur in intensive care units (ICU), 40% of which happen after the withdrawal of life-supporting therapies (WOLST). Yet, no requirements analysis identified providers’ needs or recommendations for enhancing the WOLST procedure in pediatrics. For a study, researchers sought to describe the self-reported confidence, needs, and recommendations for enhancing the WOLST process from multidisciplinary providers.
The design was convergent parallel mixed-methods. WOLST providers received an online survey in a quaternary children’s hospital between January and December 2018. The survey evaluated the clinicians’ self-reported role confidence, experiences with the WOLST process, encounters with families, opportunities for improvement, and symptom management. Kruskal-Wallis testing was performed for the quantitative data analysis, and P values <0.05 were deemed significant. SPSS v27 was used for the analysis. In addition, Atlas.ti.8 and NVivo were used to thematically analyze qualitative data.
With open-ended response choices, multiple choice, Likert-type, and yes/no questions, a total of 297 surveys (48% survey completion) were received. The median provider’s self-rated confidence was strong and considerably varied by discipline. Four areas for improving communication were found through qualitative analysis: between the primary team and family, within the primary team, between the primary team and consulting providers, and logistical difficulties.
Despite being high, participants’ self-rated confidence differed across specialties. Prior to a WOLST, participants highlighted areas for better preparation and communication. The next work will entail developing and implementing a best practice guideline to fill up the gaps and standardize the delivery of care.