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J Pediatr Intensive Care 2023; 12(01): 003-011
DOI: 10.1055/s-0041-1727179
Original Article

The Association between Therapeutic Alliance and Parental Health Outcomes following a Child's Death in the Pediatric Intensive Care Unit

Markita Suttle
1   Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Mark W. Hall
1   Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Murray M. Pollack
2   Department of Pediatrics, Children's National Hospital, Washington, United States
,
Robert A. Berg
3   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania, United States
,
Patrick S. McQuillen
4   Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California, United States
,
Peter M. Mourani
5   Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Colorado, United States
,
Anil Sapru
6   Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, California, United States
,
Joseph A. Carcillo
7   Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pennsylvania, United States
,
Emily Startup
8   Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
,
Richard Holubkov
8   Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
,
Jonathan Michael Dean
8   Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
,
Daniel A. Notterman
9   Department of Molecular Biology, Princeton University, New Jersey, United States
,
Kathleen L. Meert
10   Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, Michigan, United States
› Author Affiliations Funding This study was supported in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: UG1HD083170, UG1HD049981, UG1HD63108, UG1HD083166, UG1HD083171, UG1HD049983, U01HD049934, UG1HD050096.
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Abstract

Therapeutic alliance reflects the strength and quality of the physician–patient/family relationship. We investigated the association between therapeutic alliance and bereaved parents' mental health and perceived overall health following their child's death in a pediatric intensive care unit (PICU). Bereaved parents were surveyed 6 months after their child's death in a PICU affiliated with the Collaborative Pediatric Critical Care Research Network. Parents were evaluated for complicated grief, depression, and post-traumatic stress using the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire (PHQ-8), and the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), respectively. Overall health was evaluated using a single item. Therapeutic alliance between parents and their deceased child's PICU physicians was assessed using the Human Connection scale (HCS). Two hundred and thirty-five parents of 158 deceased children completed surveys. Mean ICG score was 34.4 ± 14.9 with 142 (60.4%) parents screening positive for complicated grief. Mean PHQ-8 score was 9.1 ± 6.2 with 102 (43.4%) screening positive for at least moderate depression. Mean SPRINT score was 14.6 ± 8.2 with 122 (51.9%) screening positive for post-traumatic stress disorder. Overall health was perceived as fair for 47 (20.0%) parents and poor for 10 (4.3%). Using multivariable modeling, higher HCS score (greater therapeutic alliance) was significantly associated with lower (better) ICG score (−0.23, 95% CI −0.42, −0.04, p = 0.018). HCS score was not significantly associated with PHQ-8, SPRINT, or overall health scores. We conclude that bereaved parents experience a high level of adverse mental health symptoms including complicated grief, depression, and post-traumatic stress symptoms. Greater therapeutic alliance with PICU physicians may lessen symptoms of complicated grief during bereavement.

Keywords

therapeutic alliance - bereavement - parent - grief - depression - post-traumatic stress disorder - pediatric intensive care unit

Supplementary Material



Publication History

Received: 14 December 2020

Accepted: 20 February 2021

Article published online:
17 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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