588 - Provider Experiences Caring for Pediatric Patients Admitted with Somatic Symptom and Related Disorders: A Qualitative Study

Publication Number: 2573.588

Nicole E. Kelly, Weill Cornell Medicine, Rockville Centre, NY, United States; Alexandra Huttle, Weill Cornell Medicine, New York, NY, United States; Georgina Hartzell, Weill Cornell Medicine, New York, NY, United States; Andrew J. Margolis, Weill Cornell Medicine, Rye Brook, NY, United States; Erika Abramson, Weill Cornell Medicine, Rye Brook, NY, United States

Background: Pediatric somatic symptom and related disorders (SSRDs) present a challenge for medical providers, particularly when patients are admitted for acute care. Pediatric hospital medicine (PHM) physicians often care for patients with SSRDs, but little is known about their experiences. Understanding the inpatient provider perspective and challenges they face is crucial to improve quality of care and treatment experience for patients with SSRDs.

Objective: We aimed to explore the experiences of PHM physicians caring for patients admitted for somatic symptom and related disorders (SSRDs) to identify barriers and facilitators to inpatient care.

Design/Methods: Using a phenomenological approach, we conducted semi-structured interviews with 20 PHM attending physicians across the United States recruited through a national PHM email listserv. Participants varied in geography, years in practice, and demographic backgrounds. Interviews were transcribed and analyzed using thematic analysis to identify recurring insights and themes.

Results: PHM attendings perceive SSRDs as challenging to manage and identified barriers and facilitators to care related to patients, caregivers, providers, institutions, and the healthcare system. Five key interrelated themes emerged: 1. When making an SSRD diagnosis, providers navigate tensions between unnecessary testing and eliminating lingering doubts about “missed” etiologies, 2. Obtaining caregiver buy-in to the diagnosis and returning patients to function are major goals of hospitalization, 3. It is challenging to establish a shared mental model of the diagnosis and treatment plan between multidisciplinary partners, the patient, and caregivers, 4. Care models for patients with SSRDs differ around the country and are negatively impacted by gaps in care coordination, and 5. Providers experience negative emotions and distress when caring for patients with SSRDs.

Conclusion(s): Hospitalists perceive a high level of responsibility to fill multiple roles when caring for children with SSRDs: achieving buy-in from patients and families, convincing subspecialists to partner in care, cultivating empathy in over-burdened trainees, and maintaining their own personal wellness. Standardizing a multidisciplinary approach and structured communication may improve provider comfort and quality of care. Further research is needed to better understand the experiences of patients and their families during admissions for SSRDs to improve diagnosis understanding and acceptance and to ultimately develop best practice guidelines.