017 Talking to families when death becomes a likely outcome – a pilot simulation programme to improve end of life conversations during and around PICU admission

End of life conversations form the basis of many complex communication scenarios in paediatric intensive care (PICU). These conversations are often initiated late in the disease process. There is evidence that many clinicians shy away from the subject matter for a wide variety of reasons. A multidisciplinary, one-day pilot simulation course to address this unmet need was designed by the PICU and palliative care teams for members of the multidisciplinary team (MDT) who admit to our PICU. The course was oversubscribed and candidates were evenly drawn from medical and senior nursing roles; specialities represented included PICU, immunology, bone marrow transplant, oncology, pulmonary hypertension and craniofacial surgery. A range of clinically complex and personally challenging clinical scenarios were developed for use with experienced educational actors. These included Previously fit and well–child post cerebrovascular accident with a deeply religious family Child with end–stage cancer whose parents had the option of an experimental treatment Child with advanced pulmonary hypertension whose parents are angry about failure of treatment Child with incurable malignancy with parents reluctant to ask for withdrawal of life–sustaining treatment but who secretly wish it to be offered. A demonstration scenario was run by the faculty for all candidates and four simulations were run in groups of four. Simulation safety and debrief tools were utilised throughout and feedback from the day was universally positive. Plans are now underway to extend this course to a wider cohort of the PICU MDT and run it on a regular basis.