title: Physician Communication in Pediatric End-of-Life Care: A Simulation Study.
abstract: OBJECTIVE
  The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life.
  
  
  METHODS
  Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent.
  
  
  RESULTS
  Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely.
  
  
  CONCLUSIONS
  Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units.
  
  
  CONCLUSIONS
  The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care.
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA loribateman@uabmc.edu.
authors.forename: Lori Brand
authors.initials: LB
authors.lastname: Bateman
authors.affiliation: Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Tofil
authors.affiliation: Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Marjorie Lee
authors.initials: ML
authors.lastname: White
authors.affiliation: Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Leon S
authors.initials: LS
authors.lastname: Dure
authors.affiliation: Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jeffrey Michael
authors.initials: JM
authors.lastname: Clair
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Belinda L
authors.initials: BL
authors.lastname: Needham
mesh_terms: D002648:Child; D003142:Communication; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D007396:Internship and Residency / Q000379:methods; D008297:Male; D016544:Patient Simulation; D010372:Pediatrics / Q000193:education*; D011368:Professional-Family Relations; D013727:Terminal Care / Q000523:psychology*
keywords: end-of-life communication; pediatric end-of-life care; physician–parent communication; qualitative methods; simulation