A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention. Michelson, K. N; Frader, J.; Charleston, E.; Rychlik, K.; Aniciete, D. Y; Ciolino, J. D; Sorce, L. R; Clayman, M. L; Brown, M.; Fragen, P.; Malakooti, M.; Derrington, S.; White, D.; and Navigate Study Investigators Pediatric Critical Care Medicine, June, 2020. Publisher: NIH Public Access
A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention. [link]Paper  doi  abstract   bibtex   
OBJECTIVES:Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. DESIGN:Patient-level, randomized trial. SETTING:Two university-based, tertiary-care children's hospital PICUs. PARTICIPANTS:Parents of patients requiring more than 24 hours in the PICU. INTERVENTIONS:PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. MEASUREMENTS AND MAIN RESULTS:The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. CONCLUSIONS:Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
@article{michelson_randomized_2020,
	title = {A {Randomized} {Comparative} {Trial} to {Evaluate} a {PICU} {Navigator}-{Based} {Parent} {Support} {Intervention}.},
	url = {http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=32639470&retmode=ref&cmd=prlinks},
	doi = {10.1097/PCC.0000000000002378},
	abstract = {OBJECTIVES:Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure.

DESIGN:Patient-level, randomized trial.

SETTING:Two university-based, tertiary-care children's hospital PICUs.

PARTICIPANTS:Parents of patients requiring more than 24 hours in the PICU.

INTERVENTIONS:PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers.

MEASUREMENTS AND MAIN RESULTS:The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4\% for PICU Supports versus 56.1\% for the brochure (estimate, 3.57; SE, 4.53; 95\% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1\%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful.

CONCLUSIONS:Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.},
	journal = {Pediatric Critical Care Medicine},
	author = {Michelson, Kelly N and Frader, Joel and Charleston, Elizabeth and Rychlik, Karen and Aniciete, Danica Y and Ciolino, Jody D and Sorce, Lauren R and Clayman, Marla L and Brown, Melanie and Fragen, Patricia and Malakooti, Marcelo and Derrington, Sabrina and White, Douglas and {Navigate Study Investigators}},
	month = jun,
	year = {2020},
	note = {Publisher: NIH Public Access},
}
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