Facilitating Shared Decision-Making in Pediatric Tracheostomy—​A Learning Module for Pediatric Intensive Care Professionals

Abstract

Clinician-investigators at the CS Mott Children’s Hospital at the University of Michigan have developed an on-line learning module to assist professionals working in the pediatric and neonatal intensive care units involved in framing and supporting decisions regarding tracheostomy placement. In these units, the incidence of tracheostomy placement with or without mechanical ventilation is increasing for children with prolonged ventilator dependence. When artificial airway or breathing support is likely to be temporary, the decision about a tracheotomy may be straightforward. However, when the prognosis is uncertain and quality of life is paramount the best way forward may not be apparent. Clinicians and parents may struggle to reach the best decision. When parents are presented with the question, “What do you want us to do?” the burden may be overwhelming. The practice of shared decision-making has been recommended to relieve this burden. Prior surveys of parents and medical providers demonstrate that exploration of parental hopes and worries surrounding tracheostomy are inadequately addressed and infrequently documented in the medical record. Little is known about how providers can best be taught skills of shared decision-making in tracheostomy.

This module was added to the required learning plans for all physicians, nurses, nurse practitioners, respiratory therapists, and social workers in the intensive care units in order to improve the process of shared decision-making in tracheostomy.

The module at the Mott Children’s Hospital was interactive and required a passing grade on the embedded quiz. The version you are seeing is not interactive, but you can find the answers to the quiz in the attached link, as well as a link to the optional survey that was available to those who completed the module including a brief report the results of that optional survey.