Go Wish Together for Pediatric Solid Organ Transplant Families
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Authors
Owens, Trudie
Issue Date
2024-12-13
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Manuscript
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Abstract
Abstract
Purpose statement: The purpose of this quality improvement project was to improve the care of patients and families of the pediatric solid organ transplant team by focusing on patient and family- centered goals of care using primary palliative care skills and the Go Wish Together conversation tool.
Background: There is significant morbidity and mortality for solid organ transplant recipients. Referrals to palliative care (PC) in this adult and pediatric population are inconsistent and often late, near the patient’s end of life. Improving quality of care through utilization of PC services can contribute to hospital savings through a reduction in LOS and reduced charges and can reduce nursing attrition. The post-transplant period can be complicated by significant symptom burden, however, referrals to palliative care in the adult and pediatric population are inconsistent and often late or at end of life.
Practice change and Implementation strategies: A convenience sample of families with pediatric patients admitted under the care of the SOT team at Nebraska Medicine was used. The process was introduced with written and verbal information by the provider to initiate the Go Wish Together Conversation Card game process. Caregivers were directed to divide the cards into categories of “very important”, “somewhat important” and “not important”. Category content wase explored and discussed with the provider. A dot phrase was utilized to communicate participation in the project and family wish preferences were entered on a “sticky note” within the electronic medical record as a reference to be utilized during team rounds.
Evaluation: This project was implemented over a six-week period with eight parents of pediatric solid organ transplant parents in the pediatric and pediatric intensive care units at a large, urban academic health center in the Midwest. “For my child to be free from machines” and “To manage appetite changes and nutrition plans for my child” were the most frequently categorized in the very important category.
Conclusions and implications for practice: A focus on family-centered goals proved to be welcomed and beneficial in helping highlight family challenges and gaps in support that exist not only within the hospital environment, but within the larger context of these families’ lives. Use of the conversation tool allowed an opportunity for caregivers to discuss their experiences and receive resources that otherwise would not have been addressed.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University