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Abstract
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OBJECTIVE: Create a framework incorporating provider perspectives of best practices for early psychosocial intervention to improve caregiver experiences and outcomes after severe pediatric traumatic brain injury (TBI).
DESIGN: Semi-structured interviews, directed content analysis.
SETTING: Level 1 trauma center, regional children's hospital.
SUBJECTS: A purposive sample of 23 healthcare providers from the emergency department, intensive care, and acute care, selected based on known clinical care of children with severe TBI. Interviews addressed team and caregiver communication processes and topics, prognostication, recommended interventions, and assessing interventions.
Measurements & Main Results: Providers recommended a dual approach of institutional and individual factors contributing to an effective framework for addressing psychosocial needs. Healthcare providers recommended interventions in three domains: (1) presenting coordinated, clear messages to caregivers; (2) reducing logistical and emotional burden of care transitions; (3) assessing and addressing caregiver needs and concerns. Specific family-centered and trauma-informed interventions included: (1) creating and sharing interdisciplinary plans with caregivers, (2) coordinating prognostication meetings and communications, (3) tracking family education, (4) improving institutional coordination and workflow, (5) training caregivers to support family involvement, (6) performing biopsychosocial assessment, and (7) using systematic prompts for difficult conversations and to address family needs at regular intervals.
CONCLUSIONS: Healthcare workers from a variety of disciplines desire incorporating certain trauma-informed and family-centered practices at each stage of treatment to improve experiences for caregivers and outcomes for pediatric patients with severe TBI. Future research should test the feasibility and effectiveness of incorporating routine psychosocial interventions for these patients.
Language: en |