Purpose: Few studies have been conducted on how pediatric clinicians cope with patient loss, and there is sparse literature to guide resource allocation specifically among pediatric transplant teams. The purpose of the present study is to determine a) how personnel on pediatric liver transplant teams cope with patient death and b) to offer recommendations for quality improvements.

Methods: With IRB approval, a Qualtrics survey link was sent to the medical director of 25 randomly selected pediatric liver transplant centers from different regions in the US. Medical directors were requested to send the link to all physicians, nurses and support personnel on their team. The survey included questions about available resources, a needs assessment, and standardized measures of adjustment (Maslach Emotional Exhaustion Scale, EE, and the Bereavement Experiences Scale, BES).

Results: Completed surveys were received from 72 respondents (32 physicians, 32 nurses, 8 social workers). The majority reported working in pediatric transplant for at least 6 years (58.9%) and experiencing 1-2 (59.7%) or 3-5 (31.9%) deaths per year. Most described having no formal training in coping with patient loss (83.3%); overwhelmingly (97.2%), respondents thought that formal debriefing procedures would be helpful, although this was routine for just 50%. Respondents frequently offered informal support to teammates (81.4%), but 29% reported that they did not receive any support. Mean scores on the EE (2.92) and the BES (1.38) were comparable to normative data, but nurses, 3.28 (SD=1.18), and social workers, 3.64 (SD=.08), reported significantly more EE than physicians, 2.39 (SD=1.02), F=7.20, p=< .01. Additionally, respondents who have formal debriefing procedures reported significantly less EE, 2.60 (SD=1.21), than those who do not have debriefing, 3.24 (SD=1.05), t=-2.40, p=.02.

Conclusions: Based on a multicenter report, there are gaps in formal resources available to pediatric liver transplant team members after experiencing patient death. Although overall team members adjust well, these findings suggest that provision of routine debriefing after loss is desired and may be associated with better coping. Further research is needed to determine if relatively higher rates of emotional exhaustion among nurses and social workers is associated with loss and patient care responsibilities specific to these roles.

CITATION INFORMATION: Duncan S, Arnon R, Dipietroantonio C, Knight C, Chu J, Annunziato R. Coping with Patient Death on Pediatric Liver Transplant Teams. Am J Transplant. 2016;16 (suppl 3).

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