Evolution of bereavement counselling in sudden infant death syndrome, neonatal death and stillbirth

Survey of psychological support for bereaved families in Japan

BACKGROUND

The aim of the present study was to investigate the current conditions of psychological support for the families of children who died suddenly of disease or accident.

METHODS

A questionnaire survey was conducted in 2415 medical facilities across the country that have at least 100 beds and are staffed by pediatricians. Of these, 981 facilities (40.6%) responded to the questionnaire.

RESULTS

There were 653 infant deaths soon after admission in 254 facilities (25.9%). For pronouncement of death, approximately 43% of the pediatricians made no attempt to provide psychological support for the family members affected. In contrast, some 53% of the pediatricians did offer psychological support. In self-assessments, approximately 53% of the pediatricians stated that the support was 'not very satisfactory' or 'unsatisfactory', while only 28% considered that they were 'fully satisfied with the help being given'. Reasons for this response were appropriate specialized knowledge, and enough time for such tasks. The proportion of institutions that employed staff specializing in psychological support for families was only 7%. Approximately 83% of institutions without such specialist staff, however, acknowledged the need for them. The number of medical facilities that gave information regarding family support associations to bereaved families was very low (11%).

CONCLUSION

Psychological support for families of children who died shortly after entering hospital cannot be characterized as satisfactory. The provision of grief care by family associations is desirable, and the cooperation of the institutions and family associations is important.

Palliative care for the family carrying a fetus with a life-limiting diagnosis

Prenatal diagnosis of a lethal anomaly is a monumental moment in a family's life. It requires extensive team counseling and planning about complex neonatal and obstetric medical management. The construct of palliative care with its focus on emotional, spiritual, social, and symptom support can provide a model for caring for these families.

A bereavement model for the intensive care nursery

The death of an infant in a neonatal intensive care unit presents unique challenges to the infant's family and caregivers. The grieving process may begin before the infant is born and continue for months, even years, after the death. Parents and families often feel isolated as they grieve the loss of a child whom few other people knew. Caregivers may also feel overwhelmed during this time, as they seek to provide decedent care in a sensitive way that will be helpful to the family while grieving themselves. Recognizing the needs of the families and caregivers, the Duke University Medical Center Intensive Care Nursery developed a bereavement program that provides education and assistance to the intensive care nursery staff, who care for the family at the time of death and provide follow-up for the family for up to one year after the death as they grieve the loss of their infant.

Perinatal hospice

When the prenatal diagnosis of a lethal fetal anomaly has been established, some patients choose to continue their pregnancy. Currently, there is a paucity of medical literature addressing the specific management of families in this unique circumstance. We propose a model of care that incorporates the strengths of prenatal diagnosis, perinatal grief management, and hospice care to address the needs of these families. We discuss the identification of candidates for this form of care; the multidisciplinary team approach; and the aspects of antepartum, intrapartum, and postpartum care. Finally, we discuss some barriers that might need to be overcome when attempting to implement perinatal hospice care.

Do child and/or parent bereavement programs work?

Bereavement programs for children and parents are becoming popular since there are more and more neonatal intensive care programs, pediatric oncology programs and pediatric intensive care programs offering these services. This paper addresses the following question: Do bereavement programs work? An overview of the literature dating back to 1964 was undertaken. Only papers dealing with treatment were reviewed. Randomized controlled trials were selected as presenting the best evidence for or against program effectiveness. Methodologic features such as description of the sample, comparability of treatment and control groups, description of the intervention, use of objective, valid, reproducible and blinded outcome measures, sample size calculations, thoroughness of follow-up and attention to clinical as well as statistical significance were assessed. Four randomized controlled trials were found in the literature search. Two of the studies showed benefit, two did not. All four suffered significant methodologic flaws. At this time it is unclear as to whether or not bereavement programs help families. Given the high costs of health care, it is important that studies be done to determine which families are likely to benefit from bereavement programs and what type of program is effective.