88 Does the Use of Multidisciplinary Debriefings After Death Decrease Healthcare Provider Psychological Distress in the Paediatric Setting?: A Rapid Review

Abstract

Abstract Background The death of a paediatric patient can result in intense grief reactions with profound psychological impacts for healthcare providers (HCPs). Due to advances in life-saving technologies and increasing clinician knowledge, death affects a small and falling proportion of critically ill children. The relative infrequency of dealing with death decreases opportunity for teams to develop effective coping interventions. Without effective coping strategies, HCPs are at high risk for acute and chronic post-traumatic stress conditions, compassion fatigue and burnout. This impacts retention of highly skilled practitioners. Psychological debriefing following death has been recognized as a team coping strategy for paediatric healthcare teams. However, not all healthcare organizations prioritize the need for HCP psychological support following traumatic emotional events in paediatric care. Objectives The objective of this review is to determine the effects of debriefing following death on the psychological well-being of paediatric health care providers. Design/Methods Based on our research question and inclusion and exclusion criteria, we searched PUBMED, Embase.com, and CINAHL. Our search strategy was developed with the assistance of a health sciences librarian, Alison Farrell. We uploaded all publications into Covidence, a software program used as the primary screening and data extraction tool for rapid reviews. Two reviewers independently screened all abstracts. We conducted full text screening using two independent researchers. A third reviewer, our research supervisor, resolved all conflicts. We used the National Institutes Health Quality Assessment tool when screening for inclusion. Health care team compositions included physicians, residents, nurses, respiratory therapists, social workers, and other support staff in various paediatric specialty areas. Intervention characteristics looked at how soon after death debriefing took place, length of the session and who facilitated the debriefing. Psychological distress was the primary outcome assessed. Secondary outcomes such as compassion fatigue and burnout were also assessed. Results Outcomes were organized based on paediatric specialty area. In paediatric and neonatal intensive care, debriefing following death reduced post-traumatic stress and staff burnout. Specific recommendations included importance of a trained person leading the debriefing. Debriefing following paediatric oncology death enhanced grief management strategies. Emergency room staff noted the importance of debriefing to maintain their own personal well-being. Themes emerged in all specialty areas, including that debriefings should be formal, timely, and professionally facilitated. Conclusion There is supportive evidence that debriefing following the death of a paediatric patient improves coping, reduces the post-traumatic stress, burnout and compassion fatigue of health care providers. Further research studies with rigorous methodology would enhance the quality of evidence.