May 21, 2006

New York, NY – Dealing with the loss of a child from a sudden traumatic illness or injury is a devastating experience for a family to face. Parents often need to make complex and difficult end-of-life decisions within a brief period of time. In an article entitled “Sudden Traumatic Death in Children,” Dr. Grace Christ, an associate professor at the Columbia University School of Social Work, and her co-authors from Harvard University discuss the diverse challenges of clinicians working with families confronting the death of a child and suggest working guidelines to respond to families going through such a traumatic experience.

Published in the June 14th issue of The Journal of the American Medical Association (JAMA), the article follows the experience of one family over a 36-hour period. The family had lost their 18-month-old toddler after a severe head injury suffered from a car accident while in the care of her grandfather. Within hours after being admitted to the hospital, her condition evolved from prognostic uncertainty to the diagnosis of brain death and considerations of organ donation.

“The difference in the perspective between the clinician’s effort to retain necessary calm through ‘routinization of disaster’ and the parents’ need for having clear acknowledgement of their catastrophe can lead to poor communication,” says Dr. Christ. “In this case, the team avoided this pitfall through having established guidelines for communication and care coordination, using empathic honesty in all discussions, and having clearly delineated roles and responsibilities within the team. The staff also effectively used ongoing and final debriefing to cope with the extraordinary emotional intensity.”

When parents of children with life-threatening conditions are interviewed about what was important and memorable to them in their child’s care, they often focus on kindness, genuineness, and empathy by health care professionals, and the critical importance of clear communication, accessibility, and continuity of care. The case study illustrated the vital roles and importance of inter-professional practice, role complementarities, and communication between social workers, physicians and nurses as they effectively built and sustained commonality and trust with the family during this tragic sequence of events.

Dr. Christ provides some guidelines that could help prepare clinicians for responding to families of children with life-threatening injury. They include:

  • Assessment – clarifying known facts about the situation in preparation for meeting the family and considering others who may be at risk for adverse reactions, such as children at home without a caregiver or distraught family members.
  • Ongoing support and information clarification – facilitating timely discussions between the family and medical and nursing staff and assure parents of the patient’s competent treatment and care.
  • Preparation of family for worsening prognosis – maintaining open communication with physicians about changing prognosis and providing support in final decisions, such as organ donation and burial preparations.
  • Follow-up contact with family – providing follow-up telephone calls and information and guidance about the ongoing grief process in children and adults.
  • Validation of the ubiquitous profound emotional responses of staff and fostering sharing and acceptance.

While these events are among the most stressful situations that clinicians encounter, optimal practice requires effective interdisciplinary teamwork in order to respond well to both medical and relational demands of an unfolding tragedy.

To read the full article, click here. For more information, please contact Jeannie Yip at 212-851-2327 or jy2223@columbia.edu.

Leave a Reply