Feasibility, Acceptability and Qualitative Analysis of a Narrative Writing Intervention with Parents of Children in Pediatric Critical Care (S557)

Feasibility, Acceptability and Qualitative Analysis of a Narrative Writing Intervention with Parents of Children in Pediatric Critical Care (S557)

Grossoehme, Daniel

Robinson, Nicole

Aultman, Julie

Friebert, Sarah

2022

1. Differentiate the content in diary and narrative 2. Locate study within the NIH ORBIT model of behavioral trial development 3. Name at least 3 writing prompts for people who may not know how to begin writing a narrative while their child is in a pediatric ICU Parents of children in a pediatric ICU (PICU) have reported mental health symptoms 6 months after discharge. Writing is associated with positive health outcomes; however, studies with adult diaries focus on factual events, and pediatric data are limited. Quantify acceptability and feasibility of a narrative intervention and qualitatively examine written texts. Prospective, proof-of-concept, 3-arm trial with legal guardians of children in the PICU of a 365-bed quaternary pediatric referral hospital. Randomly allocated participants received a blank composition book with encouragement to write (Arm 1), writing prompts (Arm 2), or at least one session (Arm 3) with narrative medicine coordinator (NMC). Feasibility was calculated as the ratio of books returned to distributed, number of books used, and ratio of completed to scheduled NMC meetings. Acceptability was measured with the Treatment Acceptability Questionnaire and the ratio of enrolled to approached persons. Descriptive statistics were calculated; between-group comparisons were made via Kruskal-Wallis tests. Thematic analysis identified emergent themes from independently coded texts. N = 20 participants enrolled in 6 months. Acceptability was high (49% enrollment; mean [SD] acceptability scores M = 24.8 [2.4]). Feasibility was good: 100% completed-to-scheduled Arm 3 sessions and 40% book return. There were significant between-group differences in journal use (chi-square = 8.7, df = 2, p = 0.013) (Arm 1, 25%; Arm 2, 80%; Arm 3, 100%). Texts revealed emotions (primarily "terrified," "angry," and "sad") yet notably expressed more cognitive processes (wishing and advice giving). The intervention was feasible and acceptable. Participants allocated to arms without the NMC appeared to produce texts with more disorganized thinking as well as lists and texts unrelated to the hospital or child's experience. Limitations include single-site, predominantly White female participants, and COVID-19 recruitment limitations. Findings warrant proceeding to a controlled pilot trial. Parents appreciated and may benefit from guided narrative opportunities while their child is in a PICU.

Journal of Pain & Symptom Management. May2022, Vol. 63 Issue 5, p937-938. 2p.

English