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Theroux R, Violette C. Fetal Anomaly: Family Experiences and Preferences for Care: An Integrative Review. J Perinat Neonatal Nurs 2023; 37:310-324. [PMID: 37878516 DOI: 10.1097/jpn.0000000000000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The prenatal diagnosis of a fetal anomaly is unexpected, creating a family crisis. Expectant parents are at an increased risk for perinatal depression and traumatic stress. Prior reviews examined parents' experiences when terminating but not continuing the pregnancy. This review synthesized qualitative research to describe the experiences, emotional responses, and needs of families continuing their pregnancy. METHODS An integrative review was performed using the Whitemore and Knafl methodology and PRISMA guidelines. A systematic review of peer-reviewed articles published between 2000 and 2200 on the experiences of fetal anomaly was performed using 5 databases. Eligible articles included qualitative studies describing families' experiences with a fetal anomaly diagnosis who elected to continue their pregnancy. Methodological quality was evaluated using the Critical Skills Appraisal Program checklist. RESULTS Of the 678 article results, 16 met inclusion criteria. There were 298 participants from 5 countries. The major overarching theme of Response to the Diagnosis of Fetal Anomaly was identified. The major categories were emotional response, coping strategies, influences, health care experiences, and family needs. Uncertainty and grief were the most common emotions. DISCUSSION Parents choosing to continue pregnancy benefit from compassionate, sensitive care, and accurate, concise information, provided in tailored instruction using multiple styles.
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Affiliation(s)
- Rosemary Theroux
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester (Dr Theroux); and UMASS Chan Medical School Obstetrics and Gynecology & Tan Chingfen Graduate School of Nursing, Worcester (Dr Violette)
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Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal Consortium. Pediatr Res 2022; 93:1728-1735. [PMID: 36167818 DOI: 10.1038/s41390-022-02314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population. METHODS We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD. RESULTS We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%). CONCLUSIONS Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models. IMPACT Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.
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Personalized support of parents of extremely preterm infants before, during and after birth. Semin Fetal Neonatal Med 2022; 27:101335. [PMID: 35780043 DOI: 10.1016/j.siny.2022.101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The emotional turmoil associated with extremely preterm birth is inescapable parents. How each parent handles the unexpected, makes sense of the unknown and learns to parent their child is uniquely personal. A rigid standardized approach to support families through their journey before and during neonatal intensive care disregards this individuality. This article reviews general concepts and practices that can be learned and applied by clinicians to promote resiliency and help parents cope adaptively. This review will describe how to personalize parenting support during the antenatal consultation and hospitalization for parents of extremely premature infants. To facilitate this, mindsets and care delivery models need to shift from inflexible standardized protocols to flexible guidelines that enable personalized communications, support structures and care delivery models tailored to each person's characteristics, preferences, and values.
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Personalized communication with parents of children born at less than 25 weeks: Moving from doctor-driven to parent-personalized discussions. Semin Perinatol 2022; 46:151551. [PMID: 34893335 DOI: 10.1016/j.semperi.2021.151551] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Communication with parents is an essential component of neonatal care. For extremely preterm infants born at less than 25 weeks, this process is complicated by the substantial risk of mortality or major morbidity. For some babies with specific prognostic factors, the majority die. Although many of these deaths occur after admission to the intensive care unit, position statements have focused on communication during the prenatal consultation. This review takes a more comprehensive approach and covers personalized and parent-centered communication in the clinical setting during three distinct yet inter-related phases: the antenatal consultation, the neonatal intensive care hospitalization, and the dying process (when this happens). We advocate that a 'one-size-fits-all' communication model focused on standardizing information does not lead to partnerships. It is possible to standardize personalized approaches that recognize and adapt to parental heterogeneity. This can help clinicians and parents build effective partnerships of trust and affective support to engage in personalized decision-making. These practices begin with self-reflection on the part of the clinician and continue with practical frameworks and stepwise approaches supporting personalization and parent-centered communication.
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Perceptions of Autism Spectrum Disorder (ASD) Etiology among Parents of Children with ASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136774. [PMID: 34202481 PMCID: PMC8297016 DOI: 10.3390/ijerph18136774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and restricted or repetitive behaviors. Parental perceptions of the etiology of their child’s ASD can affect provider–client relationships, bonding between parents and their children, and the prognosis, treatment, and management of children with ASD. Thus, this study sought to examine the perceptions of ASD etiology of parents of children with ASD. Methods: Forty-two parents of children diagnosed with ASD were recruited across Texas. Semi-structured interviews were conducted individually. All interviews were recorded and later transcribed verbatim for content analysis utilizing NVivo 12.0 (QSR International, Doncaster, Australia). Results: The content analysis identified the following themes regarding parental perceptions of ASD etiology: Genetic factors (40.5%), environmental factors (31.0%), problems that occurred during pregnancy or delivery (23.8%), vaccinations (16.7%), other health problems (7.1%), parental age at the time of pregnancy (4.8%), and spiritual or religious factors (2.4%). Conclusions: The parental perceptions of ASD etiology were diverse, but several views, such as vaccinations and spiritual or religious factors, were not based on scientific evidence. Health professionals and researchers can use these findings to develop and provide targeted education to parents who have children with ASD. Our findings also support policymakers in developing campaigns designed to increase parental ASD awareness and knowledge.
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Wilpers A, Bahtiyar MO, Stitelman D, Batten J, Calix RX, Chase V, Yung N, Maassel N, Novick G. The parental journey of fetal care: a systematic review and metasynthesis. Am J Obstet Gynecol MFM 2021; 3:100320. [PMID: 33493706 DOI: 10.1016/j.ajogmf.2021.100320] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to synthesize the qualitative literature on parental experiences of fetal care to reflect events that happened across the continuum of care and to better understand parents' positive and negative experiences with care delivery. DATA SOURCES Eligible studies published until June 2020 were retrieved from MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO CINAHL, Web of Science, and ProQuest. STUDY ELIGIBILITY CRITERIA Studies must have been: (1) published in English in a peer-reviewed journal or in ProQuest, (2) available in full text, (3) contained a qualitative component, and (4) focused on expectant parents' experiences of tertiary, coordinated, multidisciplinary prenatal diagnosis and care related to a fetal anomaly. STUDY APPRAISAL AND SYNTHESIS METHODS Researchers used the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. A metastudy and an interpretive description approach was taken to synthesize the events that happened across the continuum of care and the themes associated with a positive care experience. RESULTS The metasynthesis included 13 studies and 217 patients from 11 different multidisciplinary fetal diagnosis and intervention practices across North America and Europe. We identified key events that influenced parental experience of fetal care across the continuum. The themes associated with a positive care experience are parents (1) gaining understanding and feeling understood, (2) realizing agency and control, and (3) finding hope and meaning. We identified aspects of healthcare delivery that served as barriers or facilitators to these positive experiences. CONCLUSION Understanding the commonalities of the parental experience of fetal care across diverse settings creates a foundation for improving care and better meeting the needs of parents undergoing a painful and life-defining event. Although health outcomes are not always positive, a positive experience of care is possible and can assist parents to cope with their grief, manage their expectations, and engage in their care. The findings of this study illustrate the ways in which healthcare delivery can facilitate or obstruct a positive care experience.
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Affiliation(s)
- Abigail Wilpers
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten).
| | - Mert Ozan Bahtiyar
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - David Stitelman
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Janene Batten
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Roberto X Calix
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Victoria Chase
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Nicholas Yung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Nathan Maassel
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Gina Novick
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
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Griffiths PD, Bradburn M, Campbell MJ, Cooper CL, Embleton N, Graham R, Hart AR, Jarvis D, Kilby MD, Lie M, Mason G, Mandefield L, Mooney C, Pennington R, Robson SC, Wailoo A. MRI in the diagnosis of fetal developmental brain abnormalities: the MERIDIAN diagnostic accuracy study. Health Technol Assess 2020; 23:1-144. [PMID: 31538569 DOI: 10.3310/hta23490] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ultrasonography has been the mainstay of antenatal screening programmes in the UK for many years. Technical factors and physical limitations may result in suboptimal images that can lead to incorrect diagnoses and inaccurate counselling and prognostic information being given to parents. Previous studies suggest that the addition of in utero magnetic resonance imaging (iuMRI) may improve diagnostic accuracy for fetal brain abnormalities. These studies have limitations, including a lack of an outcome reference diagnosis (ORD), which means that improvements could not be assessed accurately. OBJECTIVES To assess the diagnostic impact, acceptability and cost consequence of iuMRI among fetuses with a suspected fetal brain abnormality. DESIGN A pragmatic, prospective, multicentre, cohort study with a health economics analysis and a sociological substudy. SETTING Sixteen UK fetal medicine centres. PARTICIPANTS Pregnant women aged ≥ 16 years carrying a fetus (at least 18 weeks' gestation) with a suspected brain abnormality detected on ultrasonography. INTERVENTIONS Participants underwent iuMRI and the findings were reported to their referring fetal medicine clinician. MAIN OUTCOME MEASURES Pregnancy outcome was followed up and an ORD from postnatal imaging or postmortem autopsy/imaging collected when available. Developmental data from the Bayley Scales of Infant Development and questionnaires were collected from the surviving infants aged 2-3 years. Data on the management of the pregnancy before and after the iuMRI were collected to inform the economic evaluation. Two surveys collected data on patient acceptability of iuMRI and qualitative interviews with participants and health professionals were undertaken. RESULTS The primary analysis consisted of 570 fetuses. The absolute diagnostic accuracies of ultrasonography and iuMRI were 68% and 93%, respectively [a difference of 25%, 95% confidence interval (CI) 21% to 29%]. The difference between ultrasonography and iuMRI increased with gestational age. In the 18-23 weeks group, the figures were 70% for ultrasonography and 92% for iuMRI (difference of 23%, 95% CI 18% to 27%); in the ≥ 24 weeks group, the figures were 65% for ultrasonography and 94% for iuMRI (difference of 29%, 95% CI 23% to 36%). Patient acceptability was high, with at least 95% of respondents stating that they would have iuMRI again in a similar situation. Health professional interviews suggested that iuMRI was acceptable to clinicians and that iuMRI was useful as an adjunct to ultrasonography, but not as a replacement. Across a range of scenarios, iuMRI resulted in additional costs compared with ultrasonography alone. The additional cost was consistently < £600 per patient and the cost per management decision appropriately changed was always < £3000. There is potential for reporting bias from the referring clinicians on the diagnostic and prognostic outcomes. Lower than anticipated follow-up rates at 3 years of age were observed. CONCLUSIONS iuMRI as an adjunct to ultrasonography significantly improves the diagnostic accuracy and confidence for the detection of fetal brain abnormalities. An evaluation of the use of iuMRI for cases of isolated microcephaly and the diagnosis of fetal spine abnormalities is recommended. Longer-term follow-up studies of children diagnosed with fetal brain abnormalities are required to fully assess the functional significance of the diagnoses. TRIAL REGISTRATION Current Controlled Trials ISRCTN27626961. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael J Campbell
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cindy L Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicholas Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ruth Graham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony R Hart
- Department of Perinatal and Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Deborah Jarvis
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Mark D Kilby
- Centre for Women's and Newborn Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust (Birmingham Health Partners), Birmingham, UK
| | - Mabel Lie
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - Laura Mandefield
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebekah Pennington
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Allan Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Communication between neonatologists and parents when prognosis is uncertain. J Perinatol 2020; 40:1412-1422. [PMID: 32382115 DOI: 10.1038/s41372-020-0673-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE When an infant's prognosis is uncertain, communication between neonatologists and parents surrounding goals of care and decision-making can be challenging. This qualitative study explored communication between neonatologists and parents to discover qualities which may enhance or impede parent-clinician partnership under such difficult circumstances. STUDY DESIGN Guided by the National Cancer Institute (NCI) Patient Centered Communication framework, semi-structured individual interviews were conducted and analyzed regarding neonatologist and parent perceptions of their communication. Subjects consisted of nine dyads of neonatologists and English-speaking parents whose infant had an uncertain prognosis. RESULTS Parents were overall satisfied with neonatologists' communications concerning their infant's uncertain trajectory. Nonetheless, both experienced challenges and distress during communication, impeding collaboration and engagement. CONCLUSIONS Families and neonatologists value principles of patient centered communication but report challenges implementing this practice. Incorporating a multidisciplinary approach in settings of prognostic uncertainty to foster patient centered communication, may enhance communication surrounding NICU care.
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Wolfe ID, Carter BS. Active or passive guidance? Decision-making in fetal health consultation. J Matern Fetal Neonatal Med 2020; 35:1787-1788. [PMID: 32366147 DOI: 10.1080/14767058.2020.1760835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prenatal consults are full of uncertainty. But, what are physicians contributing to this, and what is parents understanding of the intricacies of the complex decisions we present to them? Might the way we actively or passively guide parents affect how they make decisions in the complex world of fetal health consultations? For instance, how does "recommending" versus "not recommending" impact how parents view their choices? Reviewing the literature, there is a paucity of data on this topic. There are studies detailing experience but not of how guidance affects decision-making. We review some of this literature and discuss concepts relevant to this observation. We hypothesize that passive or active guidance by fetal health consultation members influences the moral deliberation and ethical decision-making of parents in different ways and propose a possible research idea.
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Affiliation(s)
- Ian D Wolfe
- Children's Mercy Bioethics Center, Kansas City, MO, USA
| | - Brian S Carter
- Children's Mercy Bioethics Center, Kansas City, MO, USA.,Department of Pediatrics, Neonatology, and Bioethics, University of Missouri-Kansas City, Kansas City, MO, USA
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Harris KW, Brelsford KM, Kavanaugh-McHugh A, Clayton EW. Uncertainty of Prenatally Diagnosed Congenital Heart Disease: A Qualitative Study. JAMA Netw Open 2020; 3:e204082. [PMID: 32369178 PMCID: PMC7201310 DOI: 10.1001/jamanetworkopen.2020.4082] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Parents who receive a prenatal diagnosis of congenital heart disease may experience more short- and long-term stress than those who receive a postnatal diagnosis. To identify potential interventions to ameliorate that stress, the longitudinal emotional experience of parents must first be understood. OBJECTIVE To better understand parents' accounts of their own prenatal experience, particularly aspects they found to be stressful or challenging, and to identify strategies to improve support. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included analysis of transcripts of audio recorded telephone interviews with pregnant mothers and their support persons, as applicable, who were referred to and seen at the Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May 2019 to August 2019 with an initial likely diagnosis of complex congenital heart disease at any gestational age. Data analysis was conducted from August 2019 to November 2019. MAIN OUTCOMES AND MEASURES An applied thematic analysis approach was used to code and analyze professionally transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was assessed and confirmed routinely. One author coded all transcripts; a second author independently reviewed one-fifth of the transcripts at fixed intervals to ensure that interrater reliability remained greater than 80%. RESULTS Twenty-seven individuals from 17 families participated in 42 phone interviews during pregnancy, 27 conducted at the first time point after the initial prenatal cardiology consultation and 15 at the second time point after a follow-up prenatal cardiology visit. Most interviewees were mothers (16 interviewees [59%]; median [interquartile range] age, 30.0 [27.3-34.8] years) or fathers (8 interviewees [30%)], with a few support individuals (3 interviewees [11%]) (median [interquartile range] age of family member or support individual, 30.0 [26.0-42.0] years). Initial fetal diagnoses included a range of severe congenital heart disease. Uncertainty was identified as a pervasive central theme and was related both to concrete questions on scheduling, logistics, or next steps, and long-term unknown variables concerning the definitiveness of the diagnosis or overall prognosis. Practitioners helped families through their framing of uncertainty at various time points including before, during, and after the clinic visit. CONCLUSIONS AND RELEVANCE Families walk an uncertain path following a fetal diagnosis of severe congenital heart disease. The challenges faced by the cardiologists caring for them overlap in many ways with those experienced by pediatric palliative care practitioners. Potential future interventions to improve parental support were identified in the areas of expectation setting before the referral visit, communication in clinic, and identity formation after the new diagnosis.
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Affiliation(s)
- Kelly W. Harris
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Kavanaugh-McHugh
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ellen Wright Clayton
- Division of General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
- School of Law, Vanderbilt University, Nashville, Tennessee
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11
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A simulation based difficult conversations intervention for neonatal intensive care unit nurse practitioners: A randomized controlled trial. PLoS One 2020; 15:e0229895. [PMID: 32150584 PMCID: PMC7062250 DOI: 10.1371/journal.pone.0229895] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background Neonatal nurse practitioners are often the front line providers in discussing unexpected news with parents. This study seeks to evaluate whether a simulation based Difficult Conversations Workshop for neonatal nurse practitioners leads to improved skills in conducting difficult conversations. Methods We performed a randomized controlled study of a simulation based Difficult Conversations Workshop for neonatal nurse practitioners (n = 13) in a regional level IV neonatal intensive care unit to test the hypothesis that this intervention would improve communication skills. A simulated test conversation was performed after the workshop by the intervention group and before the workshop by the control group. Two independent blinded content experts scored each conversation using a quantitative communication skills performance checklist and by assigning an empathy score. Standard statistical analysis was performed. Results Randomization occurred as follows: n = 5 to the intervention group, n = 7 to the control group. All participants were analyzed in each group. Participation in the simulation based Difficult Conversations Workshop increases participants’ empathy score (p = 0.015) and the use of communication skills (p = 0.013) in a simulated clinical encounter. Conclusions Our study demonstrates that a lecture and simulation based Difficult Conversations Workshop for neonatal nurse practitioners improves objective communication skills and empathy in conducting difficult conversations.
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Dombrecht L, Deliens L, Chambaere K, Baes S, Cools F, Goossens L, Naulaers G, Roets E, Piette V, Cohen J, Beernaert K. Neonatologists and neonatal nurses have positive attitudes towards perinatal end-of-life decisions, a nationwide survey. Acta Paediatr 2020; 109:494-504. [PMID: 30920064 DOI: 10.1111/apa.14797] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
AIM Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs. METHODS A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail. RESULTS The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death. CONCLUSION There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making.
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Affiliation(s)
- Laure Dombrecht
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Luc Deliens
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Kenneth Chambaere
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Saskia Baes
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Filip Cools
- Department of Neonatology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussel Belgium
| | - Linde Goossens
- Department of Neonatology Ghent University Hospital Ghent Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration KU Leuven Leuven Belgium
| | - Ellen Roets
- Department of Obstetrics Women's Clinic University Hospital Ghent Ghent Belgium
| | - Veerle Piette
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Joachim Cohen
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
| | - Kim Beernaert
- End‐of‐Life Care Research Group Ghent University & Vrije Universiteit Brussel (VUB) Brussel Belgium
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13
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Lee JY, Lee JH, Yeon GM, Jung YJ. Parental anxiety regarding premature infants and factors affecting parental concern. J SPEC PEDIATR NURS 2019; 24:e12266. [PMID: 31513350 DOI: 10.1111/jspn.12266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/25/2019] [Accepted: 07/12/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Premature births have a great impact on the parents. The purpose of this study was to investigate the anxieties of parents of premature infants regarding infantile diseases and to help medical staff better communicate with parents of premature infants. DESIGN AND METHODS This study included premature infants <37 weeks of age who were admitted to the Neonatal Intensive Care Unit of Kosin University Gospel Hospital between August 1, 2017, and December 31, 2017. The eligible subjects included 51 premature infants with their 75 parents (45 mothers and 30 fathers) listed in the children's medical records. Parental anxieties regarding the infants were determined by retrospective interviews at various time points as follows: before and after the birth, on postnatal Days 3 and 7, before discharge, in the first week after discharge, and at "whenever" time point. RESULTS The highest parental anxiety during all time points was regarding the respiratory system of the premature infants. Parental concerns regarding the metabolic-endocrine system of their infants significantly correlated with the presence of maternal diabetes mellitus. Parental anxiety significantly differed depending on the use of resuscitation after birth. A statistically significant difference in parental anxiety was observed in relation to the birth weight before discharge. The premature infants with bronchopulmonary dysplasia showed a significant difference in the level of parental anxiety concerning the infant's illness in the first week after discharge. CONCLUSIONS The parents of the premature infants were greatly concerned about their infants' respiratory system. Careful prenatal counseling and support are needed for mothers with diabetes.
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Affiliation(s)
- Ju Yun Lee
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jung Hyun Lee
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Gyu Min Yeon
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Yu Jin Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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14
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Humphrey JD, Hagan JL, Suresh GK, Sundgren NC. Neonatologists less frequently discuss long term complications: A simulation-based study of prenatal consults beyond the threshold of viability. J Neonatal Perinatal Med 2019; 12:87-94. [PMID: 30373964 DOI: 10.3233/npm-1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Guidelines exist for counseling expectant families of infants at periviable gestational ages (22-25 weeks), but it is much more common for neonatologists to counsel families at gestational ages beyond the threshold of viability when several aspects of these guidelines do not apply. We aimed to develop an understanding of what information is shared with mothers at risk of preterm delivery beyond periviability and to evaluate communication skills of our participants. METHODS We developed a checklist of elements to include in counseling based on a comprehensive literature review. The checklist was divided into an information sharing section and a connect score. The information sharing list was sub-divided into general information and specific complications. Neonatologists engaged in a simulated prenatal counseling session with a standardized patient. Videotaped encounters were then analyzed for checklist elements. RESULTS Neonatologists all scored well in communication using our tool and two other validated communication tools - the SEGUE and the analytic global OSCE. There was no difference in scoring based on years of experience or level of training. Information sharing from neonatologists more often discussed general information over specific. Neonatologists also focused more on early outcomes over long-term outcomes. Only 12% of neonatologists quoted the correct survival rate for the case. CONCLUSIONS Neonatologists generally communicate well but share less information specific to prematurity and the long-term sequelae of prematurity. Our tool may be used to test if other interventions improve information sharing or communication.
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Affiliation(s)
- J D Humphrey
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - J L Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - G K Suresh
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - N C Sundgren
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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15
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Blakeley C, Smith DM, Johnstone ED, Wittkowski A. Women's lived experiences of a prenatal diagnosis of fetal growth restriction at the limits of viability: An interpretative phenomenological study. Midwifery 2019; 76:110-117. [PMID: 31195219 DOI: 10.1016/j.midw.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). METHODS Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FINDINGS Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.
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Affiliation(s)
- Claire Blakeley
- University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, United Kingdom
| | - Debbie M Smith
- University of Manchester, Manchester, United Kingdom; Leeds Trinity University, Leeds, United Kingdom
| | - Edward D Johnstone
- University of Manchester, Manchester, United Kingdom; Central Manchester NHS Foundation Trust, United Kingdom
| | - Anja Wittkowski
- University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
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16
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Morton CC, Metcalfe A, Yusuf K, Sibbald B, Wilson RD. The Impact of Prenatal Diagnosis of Selected Central Nervous System Anomalies for Prenatal Counselling Based on Significant Pregnancy Morbidity and Neonatal Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:166-173.e1. [PMID: 30316708 DOI: 10.1016/j.jogc.2018.03.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/07/2018] [Accepted: 03/27/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND & OBJECTIVES Prenatal screening and diagnostic imaging advances have led to an increased detection of CNS anomalies, including ventriculomegaly/congenital hydrocephalus (HCP), Dandy-Walker malformation (DWM), and myelomeningocele (MMC). Data on pregnancy outcomes and the impact of prenatal diagnosis on neonatal outcomes is limited. Our study aimed to provide data on obstetric and neonatal outcomes following prenatal diagnosis of one of three CNS anomalies. METHODS A retrospective search of two databases in Alberta, Canada and NICU chart review of cases between 2001 and 2011was completed. Primary outcomes for each group were pregnancy outcome (live birth, stillbirth, and termination) and detection rate. Secondary outcomes were live and total birth prevalence, mode of delivery, GA at delivery, and length of NICU stay for inborn versus outborn patients. RESULTS Prenatal detection rates were 91.6% (HCP), 83.4% (DWM), and 92.9 % (MMC). Termination rates were 30.2% (DWM), 34.2% (HCP), and 48.5% (MMC). Median GA (weeks, range) at diagnosis were 22 (17-38), 20 (12-37), and 20.5 (18-34) for HCP, DWM, and MMC, respectively. Rate of Caesarean section for fetal indication was 50.0%, 44.4%, and 42.9% for HCP, DWM, and MMC, respectively. Median NICU length of stay was longer for outborn patients than inborn patients and were as follows: (range) 33.0 (21-38) versus 8.5 (1-49) d (HCP), and 29 (29-57) versus 14 (2-75) d (DWM). CONCLUSION This study provides termination rates, obstetric interventions, and NICU length of stay for prenatally-identified CNS anomalies. Collectively, this study assists prenatal counselling women with a fetus affected by a described CNS anomaly.
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Affiliation(s)
- Craig C Morton
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics & Gynecology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB
| | - Amy Metcalfe
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Kamran Yusuf
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Barbara Sibbald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB; Alberta Congenital Anomalies Surveillance System, Health Surveillance, Alberta Health & Wellness, Calgary, AB
| | - R Douglas Wilson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics & Gynecology, Saint John Regional Hospital, Horizon Health Network, Saint John, NB.
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17
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Danziger P, Laventhal N. Prenatal consultation: perspectives on training, relevance, and utilization among pediatric subspecialty program directors. J Perinatol 2018; 38:989-996. [PMID: 29740188 DOI: 10.1038/s41372-018-0121-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the experience and training of house officers in prenatal consultation, and to assess program directors' perceptions regarding adequacy of training, and relevance and utilization of prenatal consultation in their field. STUDY DESIGN An online survey was distributed to program directors of all ACGME-accredited programs in the United States in relevant pediatric subspecialties. RESULTS Ninety-five percent (142/150) of respondents agreed that prenatal consultation from their field can impact decision-making, yet 46% (69/149) believe their prenatal consult services are underutilized. The majority (56%, 86/152) reported no formal curriculum related to prenatal consultation in their program. Nine percent (14/150) rated their trainees as not adequately trained to perform competent prenatal consultation upon graduation; 35% (52/150) rated trainees as only "somewhat" competent. CONCLUSION Our study, the first of its kind, reveals widespread lack of formal training curricula, which may explain the finding that many graduating trainees are perceived as inadequately prepared to perform competent prenatal consultation.
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Affiliation(s)
- Phoebe Danziger
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, USA.
| | - Naomi Laventhal
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, USA.,Division of Neonatal-Perinatal Medicine, Ann Arbor, USA.,Center for Bioethics and Social Sciences in Medicine, Ann Arbor, USA
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18
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Robinson JR, Anders SH, Novak LL, Simpson CL, Holroyd LE, Bennett KA, Jackson GP. Consumer health-related needs of pregnant women and their caregivers. JAMIA Open 2018; 1:57-66. [PMID: 30474071 PMCID: PMC6241505 DOI: 10.1093/jamiaopen/ooy018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To build effective applications, technology designers must understand consumer health needs. Pregnancy is a common health condition, and expectant families have unanswered questions. This study examined consumer health-related needs in pregnant women and caregivers and determined the types of needs that were not met. Materials and Methods We enrolled pregnant women <36 weeks’ gestational age and caregivers from advanced maternal–fetal and group prenatal care settings. Participant characteristics were collected through surveys, and health-related needs were elicited in semi-structured interviews. Researchers categorized needs by semantic type and whether they were met (ie, met, partially met, or unmet). Inter-rater reliability was measured by Cohen’s kappa. Results Seventy-one pregnant women and 29 caregivers participated and reported 1054 needs, 28% unmet, and 49% partially met. Need types were 66.2% informational, 15.9% logistical, 8.9% social, 8.6% medical, and 0.3% other. Inter-rater reliability was near perfect (κ=0.95, P < 0.001). Discussion Common topics of unmet needs were prognosis, life management, and need for emotional support. For pregnant women, these unmet needs focused around being healthy, childbirth, infant care, and being a good mother; caregivers’ needs involved caring for the mother, the natural course of pregnancy, and life after pregnancy. Conclusion Pregnant women and caregivers have a rich set of health-related needs with many not fully met. Caregivers’ needs differed from those of pregnant women and may not be adequately addressed by resources designed for mothers. Many unmet needs involved stress and life management. Knowledge about consumer health needs can inform the design of better technologies for pregnancy.
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Affiliation(s)
- Jamie R Robinson
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, Tennessee 37232-2730, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Corresponding Author: Jamie R. Robinson, MD, MS, Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, TN 37232-2730, USA ()
| | - Shilo H Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
| | - Lauren E Holroyd
- School of Medicine, Vanderbilt University, 2215 Garland Avenue, Light Hall, Nashville, Tennessee 37203, USA
| | - Kelly A Bennett
- Department of Obstetrics and Gynecology, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
| | - Gretchen P Jackson
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, Tennessee 37232-2730, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Department of Pediatrics, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
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19
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Abstract
This article elaborates on how neonatologists and perinatologists might conceive of prognosis as an intervention with outcomes relevant to patients, families, and society at large and highlights aspects of this important area of practice requiring further study.
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Affiliation(s)
- Matthew A Rysavy
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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20
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Menzel MB, Lawrence AK, Rubio EI, Bulas DI. Team counseling in prenatal evaluation: the partnership of the radiologist and genetic counselor. Pediatr Radiol 2018; 48:457-460. [PMID: 29550868 DOI: 10.1007/s00247-017-3993-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/18/2017] [Indexed: 12/20/2022]
Abstract
Fetal medicine programs within children's hospitals have been developed to ensure access to pediatric specialists across multiple disciplines. The cases that present to these programs are usually complex and require involvement of a multidisciplinary care team. Although some providers on the team limit their focus to their pediatric specialty when counseling patients, the radiologist and genetic counselor have a distinct perspective allowing them to take the larger picture into account in the evaluation of the fetus. As first responders, they come together to review images and identify which consultants are most appropriate to counsel the families, and they can help guide patient discussions. In this paper we demonstrate how the combined expertise of the genetic counselor and pediatric radiologist can facilitate more accurate diagnoses and guide the appropriate management of complex fetal anomalies.
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Affiliation(s)
- Margaret B Menzel
- Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
| | - Anne K Lawrence
- Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Eva I Rubio
- Department of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy I Bulas
- Department of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
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21
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Gaucher N, Nadeau S, Barbier A, Payot A. Antenatal consultations for preterm labour: how are future mothers reassured? Arch Dis Child Fetal Neonatal Ed 2018; 103:F36-F42. [PMID: 28588124 DOI: 10.1136/archdischild-2016-312448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate whether the antenatal consultation for preterm labour worries or reassures women, and to identify factors contributing to these feelings. DESIGN This is a prospective survey study from April 2012 to September 2013. This mixed-methodology tool was co-constructed with patients and first tested in a single-centre pilot study. SETTING Three university-affiliated, tertiary care, high-risk obstetrics inpatient units in Quebec, Canada. PARTICIPANTS Women hospitalised with threatened preterm labour between 26 and 32 weeks' gestational age completed the survey within 72 hours of an antenatal consultation by neonatology. 341 women were invited to participate and 226 mothers completed the survey (72% response rate), at a median gestational age of 30 weeks. MAIN OUTCOME MEASURES Participant worry, reassurance and change in perception after the antenatal consultation were the main outcome measures. Multivariable logistic regression was used to identify factors associated with these outcomes. RESULTS 23% of participants were worried by the consultation, and 87% were reassured by it. Lower gestational age and higher maternal education were associated with feeling worried (adjusted OR=0.83, 95% CI 0.70 to 0.99; and adjusted OR=2.15, 95% CI 1.04 to 4.44, respectively). Longer consultations were associated with reassurance (adjusted OR=8.21, 95% CI 2.67 to 25.26). Women were reassured by (1) feeling well informed about prematurity with optimistic outlooks, and (2) a trusting and reassuring expert neonatology team. High-quality interactions with neonatologists were associated with reassurance, while poorer communications were associated with feelings of worry. CONCLUSIONS To be reassuring, neonatologists should strive to establish a trusting relationship with mothers, in which realistic and clear, but optimistic, information is offered.
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Affiliation(s)
- Nathalie Gaucher
- Division of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.,Clinical Ethics Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.,CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Quebec, Canada
| | - Sophie Nadeau
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Centre Mère Enfant Soleil, Université Laval, Quebec, Canada
| | - Alexandre Barbier
- Division of Neonatology, Department of Pediatrics, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - Antoine Payot
- Clinical Ethics Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.,CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Quebec, Canada.,Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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22
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Boss RD, Lemmon ME, Arnold RM, Donohue PK. Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors. J Perinatol 2017; 37:1224-1229. [PMID: 28749479 PMCID: PMC5688012 DOI: 10.1038/jp.2017.118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/27/2017] [Accepted: 06/26/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Delivering prognostic information to families requires clinicians to forecast an infant's illness course and future. We lack robust empirical data about how prognosis is shared and how that affects clinician-family concordance regarding infant outcomes. STUDY DESIGN Prospective audiorecording of neonatal intensive care unit family conferences, immediately followed by parent/clinician surveys. Existing qualitative analysis frameworks were applied. RESULTS We analyzed 19 conferences. Most prognostic discussion targeted predicted infant functional needs, for example, medications or feeding. There was little discussion of how infant prognosis would affect infant/family quality of life. Prognostic framing was typically optimistic. Most parents left the conference believing their infant's prognosis to be more optimistic than did clinicians. CONCLUSIONS Clinician approach to prognostic disclosure in these audiotaped family conferences tended to be broad and optimistic, without detail regarding implications of infant health for infant/family quality of life. Families and clinicians left these conversations with little consensus about infant prognosis.
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Affiliation(s)
- Renee D. Boss
- Johns Hopkins University School of Medicine,Berman Institute of Bioethics
| | - Monica E. Lemmon
- Johns Hopkins University School of Medicine,Duke University Medical Center
| | | | - Pamela K. Donohue
- Johns Hopkins University School of Medicine,Johns Hopkins Bloomberg School of Public Health
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23
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Dupont-Thibodeau A, Barrington K, Taillefer C, Janvier A. Changes in perinatal hospital deaths occurring outside the neonatal intensive care unit over a decade. Acta Paediatr 2017; 106:1456-1459. [PMID: 28434210 DOI: 10.1111/apa.13884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/13/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
AIM Perinatal deaths occurring outside the neonatal intensive care unit (NICU) are rarely recorded in outcome studies, despite having a direct impact on perinatal statistics. Our aim was to investigate the timing and modes of perinatal deaths that occurred outside the NICU and changes over time. METHOD We reviewed all perinatal deaths from 22 weeks of gestation onwards, without NICU admissions, during two periods in a Canadian tertiary mother and baby hospital and categorised deaths according to nine specific categories. RESULTS There were 444 perinatal deaths that satisfied the inclusion criteria. The total number of perinatal deaths increased from 2000 to 2002 (n = 197) and 2007 to 2010 (n = 247). The proportion of foetuses alive at the time of their mother's hospital admission, but then stillborn, decreased. There was a significant increase in terminations for congenital anomalies in the second cohort and a decrease in deaths following induction of labour and comfort care for foetal anomalies. CONCLUSION Approaches to end-of-life care changed between the two study periods. Paediatricians should be aware of the epidemiology of perinatal mortality in their own practice, as it has a direct impact on the denominator in NICU outcome studies.
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Affiliation(s)
- Amélie Dupont-Thibodeau
- Department of Paediatrics; University of Montreal; Montreal QC Canada
- Clinical Ethics Unit; Sainte-Justine Hospital; Montreal QC Canada
- Research Center; Sainte-Justine Hospital; Montreal QC Canada
- Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Palliative Care Unit; Sainte-Justine Hospital; Montreal QC Canada
| | - Keith Barrington
- Department of Paediatrics; University of Montreal; Montreal QC Canada
- Research Center; Sainte-Justine Hospital; Montreal QC Canada
- Neonatology; Sainte-Justine Hospital; Montreal QC Canada
| | - Catherine Taillefer
- Clinical Ethics Unit; Sainte-Justine Hospital; Montreal QC Canada
- Department of Obstetrics and Gynaecology; University of Montreal; Montreal QC Canada
| | - Annie Janvier
- Department of Paediatrics; University of Montreal; Montreal QC Canada
- Clinical Ethics Unit; Sainte-Justine Hospital; Montreal QC Canada
- Research Center; Sainte-Justine Hospital; Montreal QC Canada
- Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Palliative Care Unit; Sainte-Justine Hospital; Montreal QC Canada
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24
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Studer EM, Marc-Aurele KL. Lost in explanation: Lessons learned from audio-recordings and surveys of the antenatal consultation. J Neonatal Perinatal Med 2017; 9:393-400. [PMID: 27834784 DOI: 10.3233/npm-16168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine content of antenatal prematurity consultations and identify factors associated with satisfaction. DESIGN This is an observational study of consultations for possible preterm delivery. Consultations were audio-recorded and analyzed. Parents and physicians were surveyed post-consultation. RESULTS We analyzed 17 audio-recordings. Mean gestation was 28 weeks. Frequency of topics discussed were: antenatal steroids 82%, intubation 82%, breast milk 76%, time in NICU 65%, development 59%, and survival 53%. Parents frequently asked about length of hospitalization stay, feeding, and separation concerns. Parents' greatest fears were developmental problems, survival, separation from baby, infant health, and length of hospitalization. The parent satisfaction score was 8.9, and physician satisfaction score was 4.8 on a ten-point scale. No factors were found to be associated with satisfaction. Physicians felt 82% of consultations could be improved. CONCLUSIONS In consultations for possible preterm delivery, physicians discussed resuscitation details and initial neonatal care. Parental greatest fears involved more global issues. Despite content variability, parents were highly satisfied. No specific factors (such as topics discussed or length of consultation) were found to be statistically associated with parent satisfaction. Physicians were less satisfied. Providing too much/too little information was a repeated physician concern.
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Affiliation(s)
- E M Studer
- Kaiser Permanente San Diego Medical Center, San Diego, CA, USA
| | - K L Marc-Aurele
- University of California San Diego/Rady Children's Hospitals, San Diego, CA, USA
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Haward MF, Gaucher N, Payot A, Robson K, Janvier A. Personalized Decision Making: Practical Recommendations for Antenatal Counseling for Fragile Neonates. Clin Perinatol 2017; 44:429-445. [PMID: 28477670 DOI: 10.1016/j.clp.2017.01.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY 10467, USA
| | - Nathalie Gaucher
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada
| | - Antoine Payot
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada
| | - Kate Robson
- Canadian Premature Babies Foundation, Toronto, Ontario M4N 3M5, Canada
| | - Annie Janvier
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Department of Pediatrics and Clinical Ethics, Sainte-Justine Hospital, University of Montreal, 3175 Chemin Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
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Hasegawa SL, Fry JT. Moving toward a shared process: The impact of parent experiences on perinatal palliative care. Semin Perinatol 2017; 41:95-100. [PMID: 28238454 DOI: 10.1053/j.semperi.2016.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perinatal palliative care programs seek to support parents expecting a baby diagnosed with a serious medical condition. Clinicians have increasingly recognized the importance of parental perspectives on the medical care mothers and their fetuses and live-born children receive, especially regarding factors influencing individual choices and knowledge of the medical community. We describe, using literature on trisomy 13 and trisomy 18, how information shared between parents and providers can improve perinatal counseling and family support.
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Affiliation(s)
- Susan L Hasegawa
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 45, 225 E. Chicago Ave, Chicago, IL 60611
| | - Jessica T Fry
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 45, 225 E. Chicago Ave, Chicago, IL 60611.
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Carter BS. Advance care planning: outpatient antenatal palliative care consultation. Arch Dis Child Fetal Neonatal Ed 2017; 102:F3-F4. [PMID: 27688048 DOI: 10.1136/archdischild-2016-311669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 11/03/2022]
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Pichler-Stachl E, Baik-Schneditz N, Schwaberger B, Urlesberger B, Pichler G, Cheung PY, Schmölzer GM. Antenatal Consultation and Postnatal Stress in Mothers of Preterm Neonates (A Two-Center Observational Case-Control Study). Front Pediatr 2017; 5:275. [PMID: 29326912 PMCID: PMC5742535 DOI: 10.3389/fped.2017.00275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During antenatal consultation of women hospitalized for preterm labor, information of possible adverse outcomes is provided. This may however create additional maternal stress and raise some ethical concerns. OBJECTIVE The aim of the present study was to evaluate the influence of antenatal consultation by a neonatologist on maternal stress after delivery of a preterm infant admitted to NICU. METHODS In this study, secondary outcome parameters of a prospective two-center pilot observational study were analyzed. Mothers of preterm neonates < 36 weeks of gestation admitted at two tertiary-level Neonatal-Intensive-Care-Units (NICU) were included. Maternal stress was assessed with the Parental-Stress-Scale:NICU (PSS:NICU) within 72 h after birth. PSS:NICU measures three scales: "relationship and parental role," "sights and sounds," and "baby looks and behaves." Maternal sociodemographic data were collected by questionnaire administered at the same time. Mothers who received antenatal neonatal consultation were matched for gestational age and compared to mothers who had no antenatal consultation by a neonatologist. RESULTS A total of 46 mothers of preterm neonates were included, 23 mothers in each group. There was no significant difference in sociodemographic data between the two groups regarding neonates and mothers. There were no significant differences between the two groups regarding stress scales of "sights and sounds" (2.00 ± 0.76 versus 2.19 ± 0.79; p = 0.402), "looks and behaves" (2.55 ± 0.90 versus 2.48 ± 0.94; p = 0.732) and "relationship and parental role" (3.28 ± 1.23 versus 3.46 ± 1.07; p = 0.517). CONCLUSION Our study demonstrated that antenatal consultation by a neonatologist had no substantial influence on postnatal maternal stress in mothers of preterm neonates admitted to the NICU.
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Affiliation(s)
- Elisabeth Pichler-Stachl
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Austria.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
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Daboval T, Shidler S, Thomas D. Shared Decision Making at the Limit of Viability: A Blueprint for Physician Action. PLoS One 2016; 11:e0166151. [PMID: 27893823 PMCID: PMC5125593 DOI: 10.1371/journal.pone.0166151] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/23/2016] [Indexed: 12/05/2022] Open
Abstract
Objective To document interactions during the antenatal consultation between parents and neonatologist that parents linked to their satisfaction with their participation in shared decision making for their infant at risk of being born at the limit of viability. Methods This multiple-case ethnomethodological qualitative research study, included mothers admitted for a threatened premature delivery between 200/7 and 266/7 weeks gestation, the father, and the staff neonatologist conducting the clinical antenatal consultation. Content analysis of an audiotaped post-antenatal consultation interview with parents obtained their satisfaction scores as well as their comments on physician actions that facilitated their desired participation. Results Five cases, each called a “system—infant at risk”, included 10 parents and 6 neonatologists. From the interviews emerged a blueprint for action by physicians, including communication strategies that parents say facilitated their participation in decision making; such as building trustworthy physician-parent relationships, providing "balanced" information, offering choices, and allowing time to think. Conclusion Parent descriptions indicate that the opportunity to participate to their satisfaction in the clinical antenatal consultation depends on how the physician interacts with them. Practice implications The parent-identified communication strategies facilitate shared decision making regarding treatment in the best interest of the infant at risk to be born at the limit of viability.
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Affiliation(s)
- Thierry Daboval
- Children’s hospital of Eastern Ontario. Department Pediatrics. The Ottawa Hospital, Department of Obstetrics and Gynecology. University of Ottawa, Ottawa, Canada
- * E-mail:
| | - Sarah Shidler
- Department of Health Science Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Québec, Canada
| | - Daniel Thomas
- Department of Human Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Québec, Canada
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Gaucher N, Nadeau S, Barbier A, Janvier A, Payot A. Personalized Antenatal Consultations for Preterm Labor: Responding to Mothers' Expectations. J Pediatr 2016; 178:130-134.e7. [PMID: 27597734 DOI: 10.1016/j.jpeds.2016.08.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/06/2016] [Accepted: 08/03/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore prospective mothers' perspectives regarding antenatal consultations by neonatology teams for threatened preterm delivery. STUDY DESIGN In a prospective multicenter study, women at risk of preterm delivery between 26 and 32 weeks of gestational age were surveyed during the 72 hours following their antenatal consultation. The questionnaire used was developed and validated during a single-center study. RESULTS Over 18 months, 229 mothers completed the survey (73% response rate), at a median gestational age of 30 weeks. Spouses/partners were present for 49% of consultations. Most women (90%) reported a positive experience. They found it important to discuss the outcomes of prematurity (96%), but 39% of them reported receiving too much information. Women wanted their spouse/partner to be present (71%) and wished to discuss parental concerns: their roles as mother of a premature baby (82%), their integration in their baby's care (83%), and a better understanding of the neonatal intensive care unit (NICU) environment, including antenatal NICU visits (69%). The majority (56%) wanted a follow-up consultation: this was less likely if a NICU visit had been offered (P < .001), if their role as decision-maker had been discussed (P < .05), or if the consultation had lasted longer (P = .001). CONCLUSION Policy statements recommend a standardized approach to providing parents with child-centered information. Although clinicians follow these guidelines, mothers want personalized information focusing on their individual concerns and questions, such as what they can do for their baby, how NICUs work, and the integration of their family.
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Affiliation(s)
- Nathalie Gaucher
- Division of Pediatric Emergency Medicine, CHU Sainte-Justine, University of Montreal, Montreal, Canada; Clinical Ethics' Unit, CHU Sainte-Justine, University of Montreal, Montreal, Canada; CHU Sainte-Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Canada.
| | - Sophie Nadeau
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Centre Mère Enfant Soleil, Université Laval, Quebec, Canada
| | - Alexandre Barbier
- Division of Neonatology, Department of Pediatrics, McGill University Health Center, McGill University, Montreal, Canada
| | - Annie Janvier
- Clinical Ethics' Unit, CHU Sainte-Justine, University of Montreal, Montreal, Canada; CHU Sainte-Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Canada; Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada; Palliative Care Unit, CHU Sainte-Justine, Montreal, Canada
| | - Antoine Payot
- Clinical Ethics' Unit, CHU Sainte-Justine, University of Montreal, Montreal, Canada; CHU Sainte-Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Canada; Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada; Palliative Care Unit, CHU Sainte-Justine, Montreal, Canada
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Kermorvant-Duchemin E, Ville Y. Prenatal diagnosis of congenital malformations for the better and for the worse. J Matern Fetal Neonatal Med 2016; 30:1402-1406. [DOI: 10.1080/14767058.2016.1214707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chronic Critical Illness in Infants and Children: A Speculative Synthesis on Adapting ICU Care to Meet the Needs of Long-Stay Patients. Pediatr Crit Care Med 2016; 17:743-52. [PMID: 27295581 DOI: 10.1097/pcc.0000000000000792] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES In this review, we examine features of ICU systems and ICU clinician training that can undermine continuity of communication and longitudinal guidance for decision making for chronically critically ill infants and children. Drawing upon a conceptual model of the dynamic interactions between patients, families, clinicians, and ICU systems, we propose strategies to promote longitudinal decision making and improve communication for infants and children with prolonged ICU stays. DATA SOURCES We searched MEDLINE and PubMed from inception to September 2015 for English-language articles relevant to chronic critical illness, particularly of pediatric patients. We also reviewed bibliographies of relevant studies to broaden our search. STUDY SELECTION Two authors (physicians with experience in pediatric neonatology, critical care, and palliative care) made the final selections. DATA EXTRACTION We critically reviewed the existing data and models of care to identify strategies for improving ICU care of chronically critically ill children. DATA SYNTHESIS Utilizing the available data and personal experience, we addressed concerns related to family perspectives, ICU processes, and issues with ICU training that shape longitudinal decision making. CONCLUSIONS As the number of chronically critically ill infants and children increases, specific communication and decision-making models targeted at this population could improve the feedback between acute, daily ICU decisions and the patient's overall goals of care. Adaptations to ICU systems of care and ICU clinician training will be essential components of this progress.
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Marokakis S, Kasparian NA, Kennedy SE. Prenatal counselling for congenital anomalies: a systematic review. Prenat Diagn 2016; 36:662-71. [DOI: 10.1002/pd.4836] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/07/2016] [Accepted: 04/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Marokakis
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - Nadine A. Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Heart Centre for Children; The Sydney Children's Hospitals Network (Westmead and Randwick); Sydney NSW Australia
| | - Sean E. Kennedy
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Nephrology; Sydney Children's Hospital; Randwick NSW Australia
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von Hauff P, Long K, Taylor B, van Manen MA. Antenatal consultation for parents whose child may require admission to neonatal intensive care: a focus group study for media design. BMC Pregnancy Childbirth 2016; 16:103. [PMID: 27180192 PMCID: PMC4867091 DOI: 10.1186/s12884-016-0898-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For parents whose child may require admission to a neonatal intensive care unit (NICU), the antenatal consultation is often their first point of contact with the child's medical team. Consultation challenges health professionals, as parents may be anxious, overwhelmed, or even exhausted by what is and what might occur. Despite consultation being a common practice, there is a paucity of research on how to support practitioners and parents. The purpose of this study was to gain insights into important relational aspects of antenatal consultation that may be used to spur the development of media to support consultation. METHODS Focus group, as a data collection method, was employed to gather insights about antenatal consultation from a total of 50 hospital staff and 17 NICU parents from a large urban NICU program in western Canada. Qualitative content analysis was applied to the obtained materials to explicate themes that may serve as necessary understandings for media design. RESULTS Participating hospital staff and parents expressed their desire for a good antenatal consultation with comments grouped under the following themes: supporting the building of a caring relation; sharing information in conversation; and, preparing for what is to come. CONCLUSIONS To support the emerging relations of baby, parent, and hospital staff, a good antenatal consultation needs to convey care, understanding, and empathy; create possibilities for open and genuine conversations; and, foster the buildings of respect, confidence, and trust.
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Affiliation(s)
| | - Karen Long
- Northern Alberta Neonatal Program, Edmonton, AB, Canada
| | | | - Michael A van Manen
- University of Alberta, Edmonton, AB, Canada.
- Northern Alberta Neonatal Program, Edmonton, AB, Canada.
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Lechner BE, Shields R, Tucker R, Bender GJ. Seeking the best training model for difficult conversations in neonatology. J Perinat Med 2016; 44:461-7. [PMID: 26115488 DOI: 10.1515/jpm-2015-0110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/02/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We hypothesize that a formal simulation curriculum prepares neonatology fellows for difficult conversations better than traditional didactics. METHODS Single-center neonatology fellowship graduates from 1999 to 2013 were sent a retrospective web-based survey. Some had been exposed to a Difficult Conversations curriculum (simulation group), others had not (no simulation group). The simulation group participated in one workshop annually, consisting of lecture, simulation, and debriefing. Scenarios were customized to year of training. Epoch comparisons were made between the simulation and no simulation groups. RESULTS Self-rated baseline effectiveness at discussing difficult topics was not different. The simulation group reported more supervised family meetings and feedback after fellow-led meetings. Simulations were rated very positively. The simulation group reported increased comfort levels. Strategic pause and body positioning were specific communication skills more frequently acquired in the simulation group. In both groups, the highest ranked contributors to learning were mentor observation and clinical practice. In the simulation group, simulation and debriefing outranked didactics or other experiences. CONCLUSIONS Simulation-based workshops improve communication skills in high stakes conversations. However, they do not substitute for mentor observation and experience. Establishing a structured simulation-based difficult conversations curriculum refines vital communication skills necessary for the high stakes conversations neonatologists direct in clinical practice.
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36
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Pinto NM, Weng C, Sheng X, Simon K, Byrne JB, Miller T, Puchalski MD. Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease. J Matern Fetal Neonatal Med 2016; 29:3340-6. [DOI: 10.3109/14767058.2015.1125465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Boss RD, Donohue PK, Larson SM, Arnold RM, Roter DL. Family Conferences in the Neonatal ICU: Observation of Communication Dynamics and Contributions. Pediatr Crit Care Med 2016; 17:223-30. [PMID: 26684988 PMCID: PMC4779670 DOI: 10.1097/pcc.0000000000000617] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Clinicians in the neonatal ICU must engage in clear and compassionate communication with families. Empirical, observational studies of neonatal ICU family conferences are needed to develop counseling best practices and to train clinicians in key communication skills. We devised a pilot study to record and analyze how interdisciplinary neonatal ICU clinicians and parents navigate difficult conversations during neonatal ICU family conferences. DESIGN We prospectively identified and audiotaped a convenience sample of neonatal ICU family conferences about "difficult news." Conversations were analyzed using the Roter interaction analysis system, a quantitative tool for assessing content and quality of patient-provider communication. SETTING An urban academic children's medical center with a 45-bed level IV neonatal ICU. SUBJECTS Neonatal ICU parents and clinicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed 19 family conferences that included 31 family members and 23 clinicians. The child's mother was included in all conferences, and a second parent, usually the father, was present in 13 conferences. All but one conference included multiple medical team members. On average, physicians contributed 65% of all dialogue, regardless of who else was present. Over half (56%) of this dialogue involved giving medical information; under 5% of clinician dialogue involved asking questions of the family, and families rarely (5% of dialogue) asked questions. Conversations were longer with the presence of nonphysician clinicians, but this did not increase the amount of dialogue about psychosocial information or increase parent dialogue. CONCLUSIONS We collected a novel repository of audio-recorded neonatal ICU family meetings that offers insights into discussion content and process. These meetings were heavily focused on biomedical information even when interdisciplinary clinicians were present. Clinicians always talked more than parents, and no one asked many questions. Maximizing the participation of interdisciplinary clinicians in neonatal ICU family meetings may require explicit strategies. Methods to increase family engagement should be targeted.
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Affiliation(s)
- Renee D. Boss
- Johns Hopkins University School of Medicine,Berman Institute of Bioethics
| | - Pamela K. Donohue
- Johns Hopkins University School of Medicine,Johns Hopkins Bloomberg School of Public Health
| | - Susan M. Larson
- Johns Hopkins University School of Medicine,Johns Hopkins Bloomberg School of Public Health
| | | | - Debra L. Roter
- Johns Hopkins University School of Medicine,Johns Hopkins Bloomberg School of Public Health
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Medical information concerning an infant's congenital anomaly: Successful communication to support parental adjustment and transition. Disabil Health J 2016; 9:150-6. [DOI: 10.1016/j.dhjo.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/25/2015] [Accepted: 08/13/2015] [Indexed: 11/20/2022]
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Rosenstock A, van Manen M. Adolescent parenting in the neonatal intensive care unit. J Adolesc Health 2014; 55:723-9. [PMID: 25287982 DOI: 10.1016/j.jadohealth.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 08/01/2014] [Indexed: 11/26/2022]
Abstract
This review presents data from studies that report on adolescent parents as part of larger neonatal intensive care unit (NICU) parent populations, as well as studies where adolescent parents are given central consideration. A systematic search for English publications from 1990 onward relevant to adolescent parenting in the NICU was conducted. Most studies reporting on adolescent parents focus on parental stress or parenting practices in the NICU. A few studies examine parent-staff communication, parental needs, and parent intervention programs. One study presents a qualitative examination of teenage mothers' experiences in the NICU. Areas for further research include experiences of younger adolescent parents, adolescent fathers, and same-sex partners; issues unique to adolescent parents; and support programs for adolescent parents in the NICU.
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Affiliation(s)
- Amanda Rosenstock
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Michael van Manen
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada; Neonatal-Perinatal Medicine, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.
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40
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Abstract
With the development of prenatal ultrasound and of foetal medicine, the paediatric surgeon has extended his knowledge of the natural history of surgical malformations. He is a part of the prenatal team and parents should always be referred to him when a surgical malformation is suspected, even when termination of pregnancy is planned because of an expected poor prognosis. Direct contact between the prenatal medicine specialist and the paediatric surgeon is also highly recommended to ensure continuity in the messages delivered to the parents. Postnatal counselling does not compare with prenatal counselling, and the paediatric surgeon has learned from the obstetrician to modulate his talk by including other conditions that might affect the outcome of the foetus, especially genetically determined syndromes. When the foetal malformation is diagnosed very early, especially in the first trimester, it therefore seems important for the consultation with the paediatric surgeon to be scheduled when the complementary exams required by the anomalies diagnosed are done, in order to avoid later contradictory messages. Repeated consultations should be favoured as they allow provision of more precise information regarding changes in ultrasound and/or MRI images and so decrease parents׳ anxiety and help them to take their decision. Foetal surgery, which has reached various stages of development in different countries, requires paediatric surgeons and obstetricians to join forces to optimise procedures and evaluate their benefit/risk ratio. Since 2004, the National Rare Disease Plan in France has allowed the creation of Rare Disease Centres, which deal with congenital malformations and produce recommendations for the health care pathway of these patients by means of a multidisciplinary approach. This greatly enhances interdisciplinary communication and ensures that best care is provided to the parents-to-be and to their child.
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Affiliation(s)
- Alexandra Benachi
- Obstetrics, Gynecology and Reproductive Medicine Department, Antoine Béclère Hospital, AP-HP, Paris-Sud University, 157 rue de la Porte de Trivaux, 92141 Clamart, France.
| | - Sabine Sarnacki
- Paediatric Surgery Department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
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Hilton-Kamm D, Sklansky M, Chang RK. How not to tell parents about their child's new diagnosis of congenital heart disease: an Internet survey of 841 parents. Pediatr Cardiol 2014; 35:239-52. [PMID: 23925415 DOI: 10.1007/s00246-013-0765-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
An online survey for parents of children with congenital heart disease (CHD) was developed to study the perceptions and experiences of parents when receiving the diagnosis. The survey was distributed to online support groups. A total of 841 responses from parents of children with CHD in the United States were received over a 4-week period in 2010. The authors hypothesized that the counseling and demeanor of the pediatric cardiologist (PC) may be important factors in determining whether parents of children with CHD seek second opinions, and that the terminology used in counseling may be variably interpreted. Of the 841 respondents, 349 (41 %) received the diagnosis prenatally. A minority of the respondents received: support group information (14 %), Internet resources (21 %), success rates at other hospitals (16 %), or maximum ages of survivors (29 %). Among 26 % of the parents who reported seeking a second opinion from another PC, the majority (71 %) chose the second PC for long-term follow-up care. Those receiving a prenatal diagnosis were more likely to seek a second opinion than those receiving the diagnosis postnatally (32 vs 22 %; p < 0.01). Parents' perception of the PC's compassion and empathy was inversely related to the likelihood of seeking a second opinion. Parents were more likely to seek a second opinion when they were not optimistic about their child's life expectancy, felt pressured by the PC to terminate the pregnancy, were told that their child's death was "somewhat" or "very" likely, or were told the child's CHD was "rare" (all p < 0.01). Two thirds (66 %) of the respondents were told that their child's condition was "rare." The majority of these (77 %) reported that the term was used by the PC. "Rare" was interpreted as "occurring in less than a million births" by 25 %, and as "few or no other people alive with this defect" by 27 %. Parental interpretation of "rare" was unrelated to their levels of education. As reported by the respondents, 13 % felt pressured to terminate the pregnancy by the PC. Those with hypoplastic left heart syndrome were more likely to report feeling pressure to terminate the pregnancy by the PC (21 vs 9 %; p < 0.001) or the perinatologist (23 vs 14 %; p = 0.026). The approach to counseling and the demeanor of the PC have important implications for parents' perceptions of their child's chance of survival. The information given at diagnosis, the manner in which it is presented, and the parents' understanding and interpretation of that information are critical factors in shaping parents' perceptions and management decisions.
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Abstract
Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologist's goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research.
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Affiliation(s)
- Theophil A Stokes
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Katie L Watson
- Medical Humanities & Bioethics Program, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Renee D Boss
- Division of Neonatology, Department of Pediatrics. Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
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Neonatal Critical Care Communication (NC3): training NICU physicians and nurse practitioners. J Perinatol 2013; 33:642-6. [PMID: 23448940 DOI: 10.1038/jp.2013.22] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Communicating with families is a core skill for neonatal clinicians, yet formal communication training rarely occurs. This study examined the impact of an intensive interprofessional communication training for neonatology fellows and nurse practitioners. STUDY DESIGN Evidence-based, interactive training for common communication challenges in neonatology incorporated didactic sessions, role-plays and reflective exercises. Participants completed surveys before, after, and one month following the training. RESULT Five neonatology fellows and eight nurse practitioners participated (n=13). Before the training, participants overall felt somewhat prepared (2.6 on 5 point Likert-type scale) to engage in core communication challenges; afterwards, participants overall felt very well prepared (4.5 on Likert-type scale) (P<0.05). One month later, participants reported frequently practicing the taught skills and felt quite willing to engage in difficult conversations. CONCLUSION An intensive communication training program increased neonatology clinicians' self-perceived competence to face communication challenges which commonly occur, but for which training is rarely provided.
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Aite L, Zaccara A, Cuttini M, Mirante N, Nahom A, Bagolan P. Lack of institutional pathways for referral: results of a survey among pediatric surgeons on prenatal consultation for congenital anomalies. Prenat Diagn 2013; 33:904-7. [PMID: 23703679 DOI: 10.1002/pd.4165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 03/25/2013] [Accepted: 05/18/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This paper aimed to assess pathways through which pediatric surgeons receive couples for prenatal consultation after prenatal diagnosis. METHOD A questionnaire was mailed to pediatric surgical centers to assess the following: (1) surgical caseload per year; (2) number of centers in which prenatal consultation is offered; (3) presence of a 'structured' prenatal consultation clinic; (4) number of consultations per year; (5) pathways for referral to the pediatric surgeon; and (6) the availability of psychological counseling. RESULTS Response rate was 81%, (42/52 centers). Thirty-eight centers (93%) offered prenatal consultation. Seven centers (18%) reported to have a 'structured' clinic in terms of time and location. In 13 centers (34%), 1-9 consultations were carried out, from 10 to 19 in 18 centers (47%), from 20 to over 50 in 7 centers (18%). In 34 centers, internal referrals from the obstetric departments were counseled, and in 28 centers, there were also external referrals. Eleven centers reported that couples were self-referred. Information regarding prenatal counseling was available on the institutional website in 10/38 (26%) centers. Psychological counseling was available in 36 centers. CONCLUSION Despite the fact that the majority of pediatric surgical centers provides prenatal consultation, caseloads are very variable as are referral modalities.
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Affiliation(s)
- Lucia Aite
- Medical and Surgical Neonatal Department, Bambino Gesù Children's Hospital, P.zza S. Onofrio, 4, Rome, 00165, Italy.
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Wool C. State of the science on perinatal palliative care. J Obstet Gynecol Neonatal Nurs 2013; 42:372-82; quiz E54-5. [PMID: 23578106 DOI: 10.1111/1552-6909.12034] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report the state of the science since 1995 on the concept of palliative care for parents who opt to continue a pregnancy after receiving a life-limiting fetal diagnosis. DATA SOURCES PubMed, Ovid, PsycInfo, CINAHL, and Medline were searched from 1995 to July 2012 using the terms perinatal palliative care and perinatal hospice. STUDY SELECTION Inclusion criteria included empirical studies written in English that focused on experiences of parents who opted to continue a pregnancy in which the fetus had a life-limiting condition or on perinatal palliative care. Twenty studies met inclusion criteria. DATA EXTRACTION Results from empirical studies contributing to the knowledge base of perinatal palliative care are presented. DATA SYNTHESIS Women are confronted with powerful emotions, challenging decisions, and considerable uncertainty following the news of a life-limiting fetal anomaly. Women choose to continue their pregnancies for a variety of reasons and when doing so embark on a search for meaning. The science suggests that perinatal palliative care is welcomed by parents and is a medically safe and viable option. Women voiced positive feedback about their decisions to continue their pregnancies, and parents cited personal growth in the aftermath. Perinatal palliative care programs provide services that incorporate early and integrative care beginning in the antenatal period. A multidisciplinary coordinated approach provides parents with comprehensive, holistic support. CONCLUSION More research is needed to elucidate the factors that will benefit parents who continue their pregnancies. Investigating the needs and perceptions of clinicians and their willingness to participate in this new model of care is necessary as is examining barriers that may undermine care. Nurses can lead research on these topics and implement evidence-based practice grounded on study findings.
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Affiliation(s)
- Charlotte Wool
- York College of Pennsylvania, 441 Country Club Road, York, PA 17403, USA.
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Autism genetic testing: a qualitative study of awareness, attitudes, and experiences among parents of children with autism spectrum disorders. Genet Med 2013; 15:274-81. [DOI: 10.1038/gim.2012.145] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
INTRODUCTION Prenatal decision making during extremely preterm labor is challenging for parents and physicians. Ethical and logistical concerns have limited empirical descriptions of physician counseling behaviors in this setting and constricted opportunities for communication training. This pilot study examines how simulation might be used to engage neonatologists in reflecting on their usual prenatal counseling behaviors. METHODS Neonatology physicians counseled a couple (standardized patients) with the female patient having impending delivery at 23 3/7 weeks. Encounters were videotaped. Physicians completed postencounter surveys and debriefing interviews. Mixed-methods analysis explored the outcomes of clinical verisimilitude and counseling behaviors. RESULTS All 10 neonatology physicians found that the simulation was highly realistic and that their behaviors paralleled neonatologist self-report in other studies. Physicians contributed more than 80% of encounter dialogue and mostly focused on biomedical information related to the acute perinatal period. Physicians spent nearly a quarter of each encounter in building relationships and expressing empathy. Most physicians initiated discussion about quality versus quantity of life but infrequently elicited the parents' related goals and values. When medical factors and family preferences were held constant, physicians assumed variable responsibility for making decisions about resuscitation. Most physicians declined parent requests for treatment recommendations, although all of those physicians felt more than 75% certain about what should be done. CONCLUSIONS Simulation can reproduce the decisional context of prenatal counseling for extremely premature labor. These results have implications for communication training in any setting where physicians and patients without established relationships must discuss acute diagnoses and make high-stakes medical decisions.
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Brown SD, Donelan K, Martins Y, Burmeister K, Buchmiller TL, Sayeed SA, Mitchell C, Ecker JL. Differing attitudes toward fetal care by pediatric and maternal-fetal medicine specialists. Pediatrics 2012; 130:e1534-40. [PMID: 23129074 DOI: 10.1542/peds.2012-1352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The expansion of pediatric-based fetal care raises questions regarding pediatric specialists' involvement in pregnancies when maternal conditions may affect pediatric outcomes. For several such conditions, we compared pediatric and obstetric specialists' attitudes regarding whether and when pediatrics consultation should be offered and their views about seeking court authorization to override maternal refusal of physician recommendations. METHODS We used a mail survey of 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) (response rate: MFM, 60.9%; FCP, 54.2%). RESULTS FCPs were more likely than MFMs to indicate that pediatric counseling should occur before decisions regarding continuing or interrupting pregnancies complicated by maternal alcohol abuse (FCP versus MFM: 63% vs 36%), cocaine abuse (FCP versus MFM: 60% vs 32%), use of seizure medications (FCP versus MFM: 62% vs 33%), and diabetes (FCP versus MFM: 56% vs 27%) (all P < .001). For all conditions, MFMs were more than twice as likely as FCPs to think that no pediatric specialist consultation was ever necessary. FCPs were more likely to agree that seeking court interventions was appropriate for maternal refusal to enter a program to discontinue cocaine use (FCP versus MFM: 72% vs 33%), refusal of azidothymidine to prevent perinatal HIV transmission (80% vs 41%), and refusal of percutaneous transfusion for fetal anemia (62% vs 28%) (all P < .001). CONCLUSIONS Pediatric and obstetric specialists differ considerably regarding pediatric specialists' role in prenatal care for maternal conditions, and regarding whether to seek judicial intervention for maternal refusal of recommended treatment.
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Affiliation(s)
- Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA.
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Coping with the neonatal intensive care unit experience: parents' strategies and views of staff support. J Perinat Neonatal Nurs 2012; 26:343-52. [PMID: 23111723 DOI: 10.1097/jpn.0b013e318270ffe5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is stressful for parents to have an infant in the neonatal intensive care unit (NICU). To better understand the parents' experience and the role of staff, we examined parental reports of their NICU experiences, coping strategies, and views of the ways NICU staff supported them. Between June and July 2007, we interviewed 29 current and graduate parents from the study institution's NICU. A trained researcher conducted all interviews, which were recorded and transcribed. This was a qualitative analysis of prospectively collected interview data. Parents used the following coping strategies: (1) participating in care of the child; (2) getting away from the NICU; (3) gathering information; (4) involvement of friends and family; and (5) engagement with other NICU parents. Staff can support the parents' coping strategies in the following ways: (1) facilitating participation of the parents with the infant's care; (2) emphasizing documentation of the infant's progress; (3) demonstrating affection for the infant; (4) addressing concerns that make parents hesitant to leave the NICU; (5) providing accurate, consistent clinical information; (6) limiting unscheduled nonemergency phone calls; and (7) arranging voluntarily activities or programs in which parents whose infants have similar medical conditions may interact.
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Roscigno CI, Savage TA, Kavanaugh K, Moro TT, Kilpatrick SJ, Strassner HT, Grobman WA, Kimura RE. Divergent views of hope influencing communications between parents and hospital providers. QUALITATIVE HEALTH RESEARCH 2012; 22:1232-1246. [PMID: 22745363 PMCID: PMC3572714 DOI: 10.1177/1049732312449210] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study evaluated parents' and health care providers' (HCPs) descriptions of hope following counseling of parents at risk of delivering an extremely premature infant. Data came from a longitudinal multiple case study investigation that examined the decision making and support needs of 40 families and their providers. Semistructured interviews were conducted before and after delivery. Divergent viewpoints of hope were found between parents and many HCPs and were subsequently coded using content analysis. Parents relied on hope as an emotional motivator, whereas most HCPs described parents' notions of hope as out of touch with reality. Parents perceived that such divergent beliefs about the role of hope negatively shaped communicative interactions and reduced trust with some of their providers. A deeper understanding of how varying views of hope might shape communications will uncover future research questions and lead to theory-based interventions aimed at improving the process of discussing difficult news with parents.
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Affiliation(s)
- Cecelia I Roscigno
- University of North Carolina School of Nursing, Chapel Hill, North Carolina 27599-7460, USA.
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