Co-development of an intervention to support families of chronic critically ill children in paediatric critical care-The OCTO-Plus intervention.

Abstract

Families of chronic critically ill (CCI) children hospitalised in paediatric critical care (PCC) experience high stress, impaired family functioning, and multiple unmet needs. Structured, evidence-based support remains inconsistent and fragmented. Addressing all concerns requires a multicomponent, family-centred approach that integrates emotional, cognitive, and behavioural support into routine PCC practice. To report the design of a co-developed multicomponent intervention to support families of CCI children hospitalised in PCC. Development followed the updated Medical Research Council framework, focusing on five core elements: identifying uncertainties, engaging stakeholders, tailoring to context, defining program theory, and refining components and processes. The intervention is grounded in family-centred care and Calgary's family systems model, targeting affective, cognitive, and behavioural domains of family functioning through actionable tools. Stakeholder engagement included three focus groups with 11 parent partners and two focus groups with 27 healthcare professionals, to iteratively shape contextual adaptations, component selection, and delivery mechanisms. Context analysis was used to identify constraints, existing communication pathways, and opportunities to embed training and documentation within routine PCC practice and the clinical information system. Components (therapeutic family consultations, patient and family diaries, and interprofessional handovers) were modelled using the Implementation Research Logic Model and described with the Template for Intervention Description and Replication. For the OCTO-Plus intervention, stakeholders prioritised feasibility and sustainability, leading to simplification of the intervention, integration into routine PCC workflows, and creation of a practical toolbox for trained interventionists (nurses and physicians). Anticipated barriers (multicomponent complexity, scheduling) and facilitators (stable staffing, low turnover, robust clinical information systems) informed design decisions. The final delivery plan provides structured family consultations with pre and posthandovers beginning on day 8 (±48 h), repeated on day 12, weekly until discharge, at discharge, and 1 month after PCC discharge. Diaries are introduced at the first consultation to support narrative sense-making, emotional processing, and transparent communication among families and healthcare professionals. OCTO-Plus emerged from a rigorous, iterative process that emphasised contextual relevance, stakeholder partnership, and implementation readiness. The intervention is poised to enhance family functioning, communication, and continuity. Validation of its feasibility and acceptability will determine real-world uptake and sustainability in PCC.