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Sauvegrain P, Zeitlin J. Investigating the benefits and challenges of including bereaved women in research: a multifaceted perinatal audit in a socially disadvantaged French district. BMJ Open 2020; 10:e034715. [PMID: 32967867 PMCID: PMC7513560 DOI: 10.1136/bmjopen-2019-034715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To describe experiences including interviews with bereaved women in a clinical audit. DESIGN The data come from an audit of all stillbirths and neonatal deaths at ≥22 weeks of gestation in Seine-Saint-Denis, a disadvantaged French district in 2014. We included bereaved women using a questionnaire that also contained open-ended questions administered in an interview format by a midwife-investigator several weeks after the death. The study included a referral protocol for bereaved women with unmet needs revealed during the interviews. A psychological support for the three midwife-investigators was set-up, in the form of a support group. SETTING The 11 maternity hospitals in the district. PARTICIPANTS 218 women (227 deaths). ANALYSES Data come from medical records, maternal interviews, the reviews of the audit's expert panel and written narratives of their experiences provided by the midwife-investigators. Quantitative data were analysed statistically, and qualitative data thematically. RESULTS One-third (75) of the women agreed to an interview, but acceptance ranged from 6% to 60% by maternity unit. Characteristics of respondents and non-respondents were similar. Members of the audit's expert panel reported that 41% of the interviews contained new information relevant to their assessment. Of the women interviewed, 35% were referred to a medical professional, psychologist or social worker. Midwife-investigators' experiences illustrated the benefits of a support group with three main themes identified: improving their interactions with bereaved women as well as medical teams and protecting their psychological well-being. CONCLUSION These results showed that including interviews with bereaved women in audit designs was feasible and provided valuable information on women's care and social circumstances that were not available in medical records. They also highlight the importance of implementing referral protocols for the bereaved women, used in over one-third of cases, as well as providing support for study investigators.
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Affiliation(s)
- Priscille Sauvegrain
- Université de Paris, CRESS-EPOPé, INSERM, INRA, Paris, France
- Maternity Unit, GH Pitié-Salpêtrière, AP-HP, Paris, France
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Dupont C, Winer N, Rabilloud M, Touzet S, Branger B, Lansac J, Gaucher L, Duclos A, Huissoud C, Boutitie F, Rudigoz RC, Colin C. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2017. [PMID: 28649035 DOI: 10.1016/j.ejogrb.2017.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. STUDY DESIGN A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. RESULTS The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. CONCLUSIONS The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166).
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Affiliation(s)
- Corinne Dupont
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.
| | - Norbert Winer
- Service de gynécologie-obstétrique/maternité, Centre Hospitalo-universitaire de Nantes, F-44300, Nantes, France
| | - Muriel Rabilloud
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Sandrine Touzet
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Bernard Branger
- Réseau Sécurité Naissance, Pays-de-la-Loire, F-44000, Nantes, France
| | - Jacques Lansac
- Réseau périnatal de la Région Centre, F-37000, Tours, France
| | - Laurent Gaucher
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Lyon, France
| | - Antoine Duclos
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Cyril Huissoud
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Florent Boutitie
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | | | - Cyrille Colin
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
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