Children's Hospital of Michigan and the Wayne State University Department of Pediatrics have been named one of only six centers in the country to be accepted for participation in the National Institutes of Health's Collaborative Pediatric Critical Care Research Network.
Kathleen Meert, M.D., WSU professor of pediatrics, serves as principal investigator for the Detroit arm of this five-year, multi-center program designed to perform multiple clinical trials and translational research for children who are critically ill.
"It is vitally important to advance pediatric critical care. Because of the urgent demands of children in this intensive care unit (ICU) setting, current treatment modalities are based on limited tested knowledge," Dr. Meert said. "Within a pediatric intensive care unit, there are many different types of diseases--sepsis, trauma, congenital heart problems and brain tumors, for example. This makes it difficult to do sound clinical research. We need large numbers of patients with the same underlying problem to be able to expand treatment options."
According to the National Institute of Child Health and Human Development, this collaborative clinical research network will accelerate pediatric critical care research and lead to evaluation of promising new approaches to life support and critical decision-making in complex illnesses. It might take a single institution several years to gather enough data for thorough analysis, but the six NIH-designated centers working together can bring about meaningful research more rapidly. The other five centers are: Arkansas Children's Hospital, Children's National Medical Center in Washington , D.C. , Children's Hospital of Pittsburgh , Children's Hospital Los Angeles, and Children's Hospital and Regional Medical Center in Seattle . The data coordinating center is Children's Hospital in Salt Lake City , Utah .
"Given that there are 120 pediatric departments in the country, all with critical care units, the competition was fierce to become one of the first six centers in the NIH network," said Bonita Stanton, M.D., WSU chair of pediatrics. "This critical care group already has a highly productive research portfolio, and now they are participating in the establishment of a national network that is on par with the Neonatal Intensive Care Units Network, the Maternal-Fetal Medicine Unit Network, and the Pediatric Pharmacology Research Unit Network—all of which are already in operation at WSU. I am especially thrilled because the research Dr. Meert proposes deals with non-traditional topics of death and bereavement in the ICU, potentially expanding the research focus of the network beyond biomedical research to behavioral and quality of care issues. All of these areas are of great importance and overlapping in their consequences as we strive to further improve the care of critically ill children and their families."
Each qualifying principal investigator submitted a research proposal outlining the expertise he or she planned to contribute to the comprehensive research agenda. While the other centers stuck to traditional biomedical topics, Dr. Meert's $1.7 million proposal deals with critical behavioral research dealing with death and bereavement for parents of pediatric patients.
If approved as a network project, Dr. Meert plans to expand her current line of research and study "The Effect of Physician-Parent Post-Mortem Conference in Parental Grief Outcomes." Dr. Meert sees immense value in developing and testing a strategic communication intervention in which the physician who was with a child at the time of death has a personal consult with the child's parents approximately six weeks later to discuss the illness, go over autopsy reports, answer questions, offer guidance and provide compassionate counseling and bereavement resources. This meeting would be followed up for one year with measurements of the family's grief, psychological status and family relationships.
"Unfortunately, these personal meetings with grieving families rarely happen. When they do, however, we find that parents more than anything want reassurance. They want to know that the parents and doctors did all they could do. They want to know that solid decision-making took place. They want to understand more about the illness or complications and feel comforted that all best efforts were made. And general information about disease is not good enough. The parents need to rely on the relationship they formed with the physician who personally cared for the child. This can be very constructive," Dr. Meert said. She is also interested in providing best practice guidelines for physicians, for example: how to say it, tone, body language, who should attend such an intervention, etc. She is developing this encounter with Terrance Albrecht, Ph.D., a WSU professor of family medicine and health communication expert at the Barbara Ann Karmanos Cancer Institute.
"Most children who die in the United States die in hospitals, and most of those are in intensive care units. This is a difficult setting and we need to do everything we can to help the children we care for and their parents," she said.
Dr. Meert graduated from the Wayne State University School of Medicine in 1984, did her pediatric residency at the Detroit Medical Center , and since 1989 has been an attending staff at Children's Hospital and a faculty member at WSU.