O3242: What to EXPECT: A New Curriculum for Teaching Clinicians how to Prepare Patients/Families for Withdrawal of Life Sustaining Technology in the Pediatric Intensive Care Unit

Background: Most pediatric deaths occur in the pediatric intensive care unit (PICU) and result from withdrawal of life sustaining technology (WOLST).1 2. Pediatric critical care medicine (PCCM) fellows report a lack of formal training on communicating with patients/families preparing for WOLST, suggesting the need for the development of a formal curriculum.3 When examining needs for pediatric end of life, experts and scoping reviews have suggested educational initiatives focus on optimizing clinicians skill in leading conversations with patients/families, providing an accurate prognosis, and counseling on expected signs and symptoms of dying. 6,7 This study was designed to assess the effectiveness of a curriculum that teaches pediatric critical care fellows the medical knowledge and communication skills necessary to prepare patients/families for WOLST. This curriculum introduces EXPECT (Figure 1), a new tool developed and validated by the investigators through an iterative process, that serves as a prompt for communicating with patients and families facing WOLST.

Methods: All PCCM fellows, except the PCCM fellow who served as a study investigator, at Nemours Children’s Health (NCH) were eligible to enroll in this study. Enrolled participants completed a survey assessing their baseline self-efficacy caring for patients and families facing WOLST. This self-efficacy survey assessed skills based on a 5-point Likert scale with 5 indicating strongly agree and/or aspirational skill level. They then participated in an educational intervention that included 2 sessions; the first session focused on anticipating a child’s expected prognosis and symptoms following WOLST and developing a comprehensive plan for WOLST. The second session used case-based scenarios and role-play to teach skills to effectively communicate with patients and families facing WOLST. During this session, the EXPECT tool was introduced to guide these conversations. At the end of the second session, participants completed a second self-efficacy survey. Participants’ pre- and post- intervention self-efficacy scores were compared.

Results: Eight PCCM fellows (all eligible fellows) enrolled in and completed all phases of the study. Post-intervention, there was significant improvement in fellows’ reported ability to assess anticipated time to death following WOLST, inform the family the anticipated time to death following WOLST, communicate to a patient/family the plan to assess and manage anticipated symptoms following WOLST, and respond to emotion from patients/families while preparing for WOLST (Table 1).

Conclusion: A structured WOLST curriculum that includes didactic education, role-play, and the EXPECT tool improved PCCM fellows’ self-efficacy in the care of and the conversation with patients/families facing WOLST. Phase 2 of this study includes analyses of longer-term retention of skills via follow-up self-efficacy surveys.