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

Markita Suttle; Mark W. Hall; Murray M. Pollack; Robert A. Berg; Patrick S. McQuillen; Peter M. Mourani; Anil Sapru; Joseph A. Carcillo; Emily Startup; Richard Holubkov; Jonathan Michael Dean; Daniel A. Notterman; Kathleen L. Meert

doi:10.1055/s-0041-1727179

Journal of Pediatric Intensive Care, Table of Contents

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

¹Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States

,

Mark W. Hall

¹Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States

,

Murray M. Pollack

²Department of Pediatrics, Children's National Hospital, Washington, United States

,

Robert A. Berg

³Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania, United States

,

Patrick S. McQuillen

⁴Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California, United States

,

Peter M. Mourani

⁵Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Colorado, United States

,

Anil Sapru

⁶Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, California, United States

,

Joseph A. Carcillo

⁷Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pennsylvania, United States

,

Emily Startup

⁸Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States

,

Richard Holubkov

⁸Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States

,

Jonathan Michael Dean

⁸Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States

,

Daniel A. Notterman

⁹Department of Molecular Biology, Princeton University, New Jersey, United States

,

Kathleen L. Meert

¹⁰Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, Michigan, United States

› Author Affiliations

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

Full Text

References

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Supplementary Material