(880) Multidisciplinary Clinician Perspectives on Barriers to Communicating About Pediatric Brain Death

Introduction: Communicating about death by neurologic criteria (DNC), or brain death, presents a complex challenge for multidisciplinary providers in pediatric critical care and neurology. The heterogeneity of state-level and institutional DNC policies drives variability in clinical practice patterns, complicating clear and consistent messaging about this nuanced end-of-life domain. Provider-family communication in DNC cases is identified as a critical target for research and educational intervention, but little is known about what multidisciplinary clinicians perceive to be barriers to successful communication among team members and with families.

Methods: We performed a qualitative study using semi-structured interviews with physicians, nurses, and social workers at a single center. Iterative, inductive coding and thematic analyses were utilized to identify themes pertaining to clinician perspectives on barriers to successful communication and strategies for improvement.

Results: Twenty-two multidisciplinary pediatric clinicians (intensivists, neurologists, registered nurses, and clinical social workers) participated. Clinician-based barriers identified included moral distress, inconsistent messaging, prognostic uncertainty, and tension between maintaining hope and conveying reality, while patient/family-based barriers included family discord, lack of trust, and discrepant provider-family values. Clinicians identified strategies to overcome barriers and improve inter-team and team-family communication, including conducting early, transparent conversations, employing consistent rhetoric, ensuring presence of multidisciplinary stakeholders for key conversations, reframing anger as a symptom of grief, and practicing compassion in place of judgment.

Conclusions: Despite widespread recognition of the importance of clear communication in discussions pertaining to DNC, various clinician-based and patient/family-based barriers that interfere with effective communication were identified. Proposed actionable strategies to circumvent barriers should prioritize establishing a shared mental model and consistent messaging in addition to employing a humanistic approach. This work informs future communication-based interventions aimed at improving end-of-life care for patients facing DNC.