(110) Assessing Pediatric Physician Perspectives on Routine Code Status Discussions

Monday, January 22, 2024

11:30 AM – 12:30 PM MT

Location: Connections Central - RST 10

First Author(s)

Rachel R. Hill, MD, (she/her/hers)

UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania

Co-Author(s)

SM

Scott Maurer, MD

Associate Professor of Pediatrics
UPMC Children's Hospital of Pittsburgh, United States
MC

Michael Certo, MD, MA,

Attending Physician, Pediatric Critical Care and Palliative Care
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States

Introduction: Pediatric code status discussions are often deferred until death is imminent.(1) There is scarce data on barriers to code status discussions in pediatrics. This single-center, survey-based study identifies barriers and concerns among pediatric physicians regarding code status discussions.

Methods: Pediatric residents, fellows, and attendings in general pediatrics and 12 pediatric medical subspecialties completed anonymous surveys about 4 scenarios (2 in medically complex children, 2 in previously healthy children). Using a Likert scale, participants were asked about the necessity of discussing code status and perceived barriers.

Results: 71 attendings, 53 fellows, and 82 residents completed the survey (47% response rate). Most felt they had the time (72%) and training (68%) to ask about code status. Trainees were more concerned than attendings about upsetting other physicians (36%; 19%; p< 0.01), creating confusion (38%; 16%; p< 0.01), increasing parental anxiety (73%; 46%; p< 0.01) or anger (46%; 18%; p< 0.01), and implying the team was “giving up” (41%; 14%; p< 0.01). In scenarios with medically complex children, nearly all respondents felt it was necessary to ask about code status compared to scenarios with acutely ill healthy children (92%; 28%; p< 0.01). Compared to medically complex scenarios, responses involving otherwise healthy children garnered more concerns about parental anxiety (74%; 54%; p< 0.01) or anger (41%; 31%; p< 0.01), or not being the “right person” to discuss code status (13%; 7%; p< 0.01).

Conclusions: In case scenarios, this sample of pediatricians notes emotional barriers to assessing code status in children, especially amongst trainees. These barriers were more pronounced in scenarios involving otherwise healthy children; however, studies suggest that code status documentation is rare regardless of medical complexity.(2) Future work should address strategies to mitigate trainee-specific barriers and determine if caregivers share these concerns.

1.Sanderson A, Zurakowski D, Wolfe J. Clinician Perspectives Regarding the Do-Not-Resuscitate Order. JAMA Pediatr. 2013;167(10):954.
2. Battisti KA, Cohen DM, Bourgeois T, et al. A Paucity of Code Status Documentation Despite Increasing Complex Chronic Disease in Pediatrics. J Palliat Med. 2020;23(11):1452-59.