Sharing Serious News in Pediatrics

by Tanya D. Murtha, MD, MPH, MHS

Communicating bad news to parents and families is a difficult task for any healthcare professional.

At Hasbro Children’s Hospital, we are working hard to improve and expand the education of our physicians around sharing serious news:

• The Pediatric Intensive Care Unit (PICU) monthly curriculum now includes a lecture on the topic that is paired with information on pediatric organ donation from Tamara Sexton, Rhode Island Hospital in-house coordinator for New England Donor Services.
• Our Children’s Integrative Therapy Pain Management and Supportive Care Program (ChIPS) pediatric palliative care team, led by Rebecca MacDonell-Yilmaz, MD, is also partnering with the adult palliative and pediatric critical care teams to improve resident and intern education.
• Finally, in May, I presented “Sharing Serious News in the PICU” at Grand Rounds for the neurosurgeons and neurosurgery residents of the department of neurosurgery.

These educational efforts have centered around two important aspects for sharing serious news:

1. To have a framework for these conversations
2. To recognize and promote the importance of interprofessional teamwork when sharing serious news.

The framework taught at Hasbro is GUIDE from VitalTalk.

View the GUIDE tool

The major thing is to be the mediator so both parties are understanding each other and get what they want out of the meeting.

In the future, this work will expand beyond physician education to include other members of the care team, such as nursing, social work, chaplaincy, care coordinators, patient advocates, and more. My team is completing a qualitative study that identified the substantial, varied, and essential roles that non-physician team members play during the process of sharing serious news with the patients and families of pediatric patients.

A pediatric ICU nurse interviewed for the study described how they serve as a bridge between the family and physicians:  “The major thing is to be the mediator so both parties are understanding each other and get what they want out of the meeting. The provider is able to tell the family the information that they need to know and I make sure that they fully understand it, feel heard, and have their questions answered.” 

This research will inform further development of sharing serious news education, with the hope to eventually hold interprofessional simulations in which “bad news” is given to simulated patients, enabling the entire team to practice this challenging skill, debrief together, and share expertise.