564 - Navigating Consent in the PICU: Perspectives of Caregivers, Physicians, and Nurses on Invasive Procedures

Publication Number: 1542.564

Rachel E. Moss, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mariana Budge, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Katherine Guttmann, Icahn School of Medicine at Mount Sinai, Larchmont, NY, United States; Annabelle Elikan, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Nihal Mohamed, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Shubhi Kaushik, Icahn School of Medicine at Mount Sinai, NY, NY, United States

Background: In the PICU, invasive procedures are frequent, yet caregiver understanding is often limited. For non-emergent procedures, physicians obtain consent, but this process lacks standardization. Studies show many caregivers do not fully comprehend the information shared. Both caregivers and clinicians value shared-decision making, bust stress, confusion, and language barriers hinder understanding. Caregivers with language other than English (LOE) preference often experience poorer communication.

Objective: To explore perceptions of procedural consent and the role of language, we conducted a qualitative study among caregivers of critically ill children and ICU clinicians.

Design/Methods: We performed semi-structured interviews with English- or Spanish-preferring caregivers of children who underwent bedside invasive procedures in a quaternary urban PICU. Procedures included intubation, sedation, arterial or central line placement, lumbar puncture, and thoracentesis. Additional interviews were conducted with physicians, nurses, and APPs who obtained or witnessed consent.
Interviews were conducted until thematic saturation. Data were analyzed using rapid qualitative methods with a structured matrix to identify cross-cutting themes. We interviewed 16 caregivers and 19 staff members (Tables 1,2).

Results: Four themes emerged among caregivers: Mixed understanding of medical terminology; Variable trust and limited shared decision-making; Significant emotional and psychological strain; Miscommunication and fear amplified for Spanish-speaking caregivers.
Five themes emerged among staff: Lack of standardized consent process, challenges with interpreter use, there is a high emotional toll of caring for critically ill children, barriers to understanding and relationship-building with LOE patients, and there is a need for standardized and language-concordant consent process (Tables 3,4).

Conclusion(s): Invasive procedures in pediatric critical care provoke fear and misunderstanding, worsened by language barriers. Caregivers often cannot identify their child's procedure or recall key details despite clinicians' efforts. Both caregivers and staff experience emotional strain. Standardizing and simplifying the consent process-ensuring language concordance and matching caregiver health literacy-may foster shared decision-making and improve trust and understanding in the PICU.

Demographics of Caregivers and Personnel


Clinician Themes


Caregiver Themes