51
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Cortezzo DE, Bowers K, Cameron Meyer M. Birth Planning in Uncertain or Life-Limiting Fetal Diagnoses: Perspectives of Physicians and Parents. J Palliat Med 2019; 22:1337-1345. [PMID: 31063010 DOI: 10.1089/jpm.2018.0596] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Providers often use birth plans to document parents' wishes for their fetus with a life-limiting condition. Objective: The objective of the study was to (1) discover important components of a birth plan for parents and providers who carry them out, and (2) understand the experience of parents and providers with birth plans. Methods: The study design involves mixed-methods, descriptive, exploratory survey. This involves parents (n = 20) of a pregnancy complicated by a life-limiting diagnosis and providers who care for them (n = 116). The approach involves descriptive and univariate analyses for quantitative data and thematic analysis for qualitative data. Results: Consistent components for families and physicians were diagnosis and medical management of the infant. Families gave greater emphasis on memory-making preferences. Parents feel birth plans give them a sense of control. Themes emerged from parents' experience of creating a birth plan are as follows: sense of control, therapeutic, memory making, effective communication, feeling prepared, and unexpected events. Most physicians feel comfortable discussing goals of care with families but report insufficient time. The importance of components of birth plans and perception of the parents' understanding of the prognosis varied by specialty. Discussion: Birth plans are beneficial and provide a greater sense of control for parents. Most physicians feel comfortable utilizing them. More than one-third of the physicians do not feel that they have time to complete a birth plan with parents. Communication between physicians and families about limitations of the plan and the potential trajectories could be improved. Communication between maternal and neonatal care providers regarding parent expectations and understanding could also be improved.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine Bowers
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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52
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Beyond a Seat at the Table: The Added Value of Family Stakeholders to Improve Care, Research, and Education in Neonatology. J Pediatr 2019; 207:123-129.e2. [PMID: 30922490 DOI: 10.1016/j.jpeds.2018.11.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To analyze activities involving veteran resource parents and patients in a family partnership program; their perspectives were also explored. STUDY DESIGN The multiple roles assumed by family stakeholders in neonatal initiatives were reviewed. Quality control questionnaires were distributed to resource parents and patients and providers who worked with them. Mixed methods were used to analyze results. RESULTS Thirty resource parents and patients were involved in a total of 653 activities related to clinical care (n = 413), teaching (n = 31), and research (n = 209); 7 initiatives were described to illustrate the positive impact of family stakeholders on clinical care, teaching, and/or research. Resource parents and patients had different degrees and intensity of involvement: all were involved in low-risk initiatives and 9 in more complex activities. In the questionnaire, family stakeholders all described positive impacts associated with their participation and benefits to themselves, such as meaning making. Three resource parents reported traumatic memories that occurred during medical simulations. The majority of providers report that resource parents and patients improved their projects, but some also report this new collaboration is complex. CONCLUSIONS Although stakeholder participation increasingly is recommended, practical knowledge and the impact of their participation is scarce. Having several resource parents and patients bring their contributions may be more valuable than a few "expert stakeholders." Recruiting and orienting resource parents and patients toward different types of activities should take into account the complexity and risks of the tasks. Family stakeholders are appreciated and have a positive impact on projects in which they are involved.
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53
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Janvier A, Bourque CJ, Dahan S, Robson K, Barrington KJ. Integrating Parents in Neonatal and Pediatric Research. Neonatology 2019; 115:283-291. [PMID: 30799397 DOI: 10.1159/000492502] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parents and their infants are the beneficiaries of neonatal and pediatric research, but in the past they have been excluded from most stages of research projects. As a result, many projects may fail to produce the most worthwhile information for parents and families. Lately, veteran resource parents and patients have been increasingly integrated in research initiatives. METHODS Benchmarking of neonatal and pediatric research initiatives where resource parents and/or ex neonatal patients have helped to optimize pediatric research. We review ways in which resource parents/patients can be involved in research, with examples and practical ideas of how to proceed. RESULTS Resource parents/patients can be collaborators in research and be integrated in many steps: prioritizing research projects, designing trials, determining the outcomes of interest, ethics review, developing and improving consent procedures, collection and interpretation of data, participation in data safety monitoring committees, publication of results, and presentation to peer groups. Some of the strategies for integration of stakeholders in clinical research are more complex, may involve risk and require more training than others. CONCLUSION We suggest that groups wanting to involve parents in their research endeavors start with simpler tasks that entail less risk and develop teams of resource parents who have differing interests and abilities. Quality control of programs is essential, such as frequently giving and obtaining feedback from resource parents/patients and researchers. In the future, integration of resource parents/patients into every step of clinical research will be essential to ensure that parent and family important outcomes are examined.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada, .,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,CHU Sainte-Justine Research Center, Montréal, Québec, Canada, .,Bureau de l'Éthique Clinique, Université de Montréal, Montréal, Québec, Canada, .,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Soins Palliatifs, Hôpital Sainte-Justine, Montréal, Québec, Canada, .,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada,
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité de Recherche en Éthique Clinique et Partenariat Famille (UREPAF), Montréal, Québec, Canada
| | - Sonia Dahan
- Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,Unité d'Éthique Clinique, Hôpital Sainte-Justine, Montréal, Québec, Canada
| | - Kate Robson
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Keith James Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,Division of Neonatology, Hôpital Sainte-Justine, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
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54
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Weaver MS, Starr LJ, Austin PN, Stevenson CL, Hammel JM. Eliciting Narratives to Inform Care for Infants With Trisomy 18. Pediatrics 2018; 142:peds.2018-0321. [PMID: 30190348 DOI: 10.1542/peds.2018-0321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/24/2022] Open
Abstract
: media-1vid110.1542/5804913218001PEDS-VA_2018-0321Video Abstract.
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Affiliation(s)
- Meaghann S Weaver
- Divisions of Palliative Care and .,Departments of Oncology, Pediatrics and
| | - Lois J Starr
- Division of Clinical Genetics, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska; and
| | | | | | - James M Hammel
- Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, Nebraska
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55
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Pyle AK, Fleischman AR, Hardart G, Mercurio MR. Management options and parental voice in the treatment of trisomy 13 and 18. J Perinatol 2018; 38:1135-1143. [PMID: 29977011 DOI: 10.1038/s41372-018-0151-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/11/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Alaina K Pyle
- Department of Pediatrics and Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, USA.
| | - Alan R Fleischman
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY, USA
| | - George Hardart
- Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital, New York City, NY, USA
| | - Mark R Mercurio
- Department of Pediatrics and Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT, USA
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56
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Wightman A, Goldberg A, Diekema D. Fairness, severe intellectual disability, and the special case of transplantation. Pediatr Transplant 2018; 22:e13228. [PMID: 29785805 DOI: 10.1111/petr.13228] [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] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
Abstract
Children with severe intellectual disability have historically been excluded from solid organ transplantation. The purpose of this article was to review the arguments for excluding this population, including claims of poorer recipient and graft survival, a lower QoL as pediatric recipients become adults, and poorer outcomes for other, more deserving pediatric transplant candidates, and make the case that these arguments are no longer persuasive. We will argue that pediatric transplant centers for reasons of social justice, value of relationships, power differential, and fairness should generally not consider intellectual ability or disability as a criterion when making decisions regarding organ transplant eligibility.
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Affiliation(s)
- Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
| | - Aviva Goldberg
- Department of Pediatrics, University of Manitoba College of Medicine, Winnipeg, MB, Canada
| | - Douglas Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA, USA
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57
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Winn P, Acharya K, Peterson E, Leuthner S. Prenatal counseling and parental decision-making following a fetal diagnosis of trisomy 13 or 18. J Perinatol 2018; 38:788-796. [PMID: 29740195 DOI: 10.1038/s41372-018-0107-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/06/2018] [Accepted: 03/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate parental decisions following a prenatal diagnosis of trisomy 13 (T13) or trisomy 18 (T18), prenatal counseling received, and pregnancy outcomes. STUDY DESIGN Single-center, retrospective cohort study of families with a prenatal diagnosis of T13 or T18 from 2000 to 2016. RESULTS Out of 152 pregnancies, 55% were terminated. Twenty percent chose induction with palliative care, 20% chose expectant management, 2% chose full interventions, and 3% were lost to follow-up. Counseling was based on initial parental goals, but most women were given options besides termination. Women who chose expectant management had a live birth in 50% of the cases. Women who chose neonatal interventions had a live birth in 100% of the cases, but there were no long-term survivors. CONCLUSIONS The majority of women who continue their pregnancy after a fetal diagnosis of T13 or T18 desire expectant management with palliative care. A live birth can be expected at least half of the time.
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Affiliation(s)
- Phoebe Winn
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erika Peterson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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58
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Crowe L, Graham RH, Robson SC, Rankin J. A survey of health professionals' views on acceptable gestational age and termination of pregnancy for fetal anomaly. Eur J Med Genet 2018; 61:493-498. [PMID: 29777898 DOI: 10.1016/j.ejmg.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
Abstract
Termination of pregnancy for fetal anomaly is legal in the UK with no upper limit, if two doctors, in good faith, agree "there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped". This is Clause E of the Human Fertlisation and Embryology Act. The most commonly sighted Clause is C, which states "the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman". This study aimed to investigate health professionals' views on gestational age and acceptable termination of pregnancy for fetal anomaly (TOPFA). We undertook a questionnaire survey of UK health professionals working in fetal medicine, obstetrics and gynaecology and neonatology. A study pack consisting of a self-completion questionnaire, an invitation letter, participant information sheet, and a stamped addressed return envelope, were sent to health professionals. We used four fetal anomalies as case study examples in the questionnaire: isolated cleft lip, hypoplastic left heart, spina bifida and trisomy 21. These anomalies were chosen as they differed in terms of the type of anomaly, the type of impairment, and the perceived severity. Forty-one study packs were returned. For anomalies deemed less serious, later gestational ages were an important consideration when deciding acceptable TOPFA. The prognosis of an anomaly was considered an important factor in deciding whether a TOPFA was acceptable alongside gestational age. Clause C of the current UK legislation, which allows a legal termination prior to 24 weeks gestational age if continuing with the pregnancy would impact the mental health of the mother, was deemed a reasonable option for termination when parents are requesting a TOPFA. For each case study example, health professionals responded that TOPFA at '25 weeks and over' was acceptable (cleft lip n = 1; hypoplastic left heart n = 19; spina bifida n = 13 and Trisomy 21 n = 10). Professionals also distinguished between their personal and professional views. These findings offer new insight into how gestational age considerations influence professionals' conceptualisation of acceptable TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK.
| | - Ruth H Graham
- School of Geography, Politics and Sociology, 5th Floor Claremont Bridge Building, Newcastle University, NE1 7RU, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, 3rd Floor William Leech Building, Newcastle University, NE2 4HH, UK
| | - Judith Rankin
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK
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59
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Hodgson J, McClaren BJ. Parental experiences after prenatal diagnosis of fetal abnormality. Semin Fetal Neonatal Med 2018; 23:150-154. [PMID: 29258838 DOI: 10.1016/j.siny.2017.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
For many pregnant women, prenatal testing is a routine component of contemporary pregnancy care. Receiving a prenatal diagnosis is frequently associated with intense feelings of shock and grief; the extent of which may be unrelated to the pregnancy gestation or the condition diagnosed. During this time of crisis, parents are often faced with important choices about their pregnancy. Levels of understanding and experiences of professional support throughout this time likely impact decisions that are made and how they are subsequently perceived. Despite considerable advances in prenatal testing technologies over the last 20 years there is a paucity of research examining parental experiences in-depth. Future advances such as prenatal exome sequencing will further increase the scope of prenatal testing and numbers of parents who receive a prenatal diagnosis. It is imperative that large-scale studies are performed to ensure that protocols are in place to adequately support couples at this time.
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Affiliation(s)
- Jan Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Genetics Education and Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Belinda J McClaren
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Genetics Education and Health Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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60
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Fruhman G, Miller C, Amon E, Raible D, Bradshaw R, Martin K. Obstetricians' views on the ethics of cardiac surgery for newborns with common aneuploidies. Prenat Diagn 2018; 38:303-309. [DOI: 10.1002/pd.5225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/21/2018] [Accepted: 01/25/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gary Fruhman
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
- Northwell Health, Department of Obstetrics and Gynecology; Staten Island University Hospital; Staten Island NY USA
| | - Collin Miller
- Division of Research, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Erol Amon
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Darbey Raible
- Department of Pediatrics; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Rachael Bradshaw
- Department of Pediatrics; Saint Louis University School of Medicine; Saint Louis MO USA
| | - Kimberly Martin
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health; Saint Louis University School of Medicine; Saint Louis MO USA
- Natera Inc.; San Carlos CA USA
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61
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Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: a qualitative study of professional perspectives. BMJ Open 2018; 8:e020815. [PMID: 29500216 PMCID: PMC5855171 DOI: 10.1136/bmjopen-2017-020815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to explore the perspectives of professionals around the issue of termination of pregnancy for non-lethal fetal anomaly (TOPFA). METHODS Semi-structured interviews were undertaken with medical professionals (14 consultants in fetal medicine, obstetrics, neonatology and paediatrics) and social care professionals (nine individuals with roles supporting people living with impairment) from the Northeast of England. Analysis adopted an inductive thematic approach facilitated by NVivo. RESULTS The overarching theme to emerge from the interview data was of professionals, medical and social care, wanting to present an acceptable self-image of their views on TOPFA. Professionals' values on 'fixing', pain and 'normality' influenced what aspects of moral acceptability they gave priority to in terms of their standpoint and, in turn, their conceptualisations of acceptable TOPFA. Thus, if a termination could be defended morally, including negotiation of several key issues (including 'fixing', perceptions of pain and normality), then participants conceptualised TOPFA as an acceptable pregnancy outcome. CONCLUSION Despite different professional experiences, these professional groups were able to negotiate their way through difficult terrain to conceptualise TOPFA as a morally acceptable principle. While professionals have different moral thresholds, no one argued for a restriction of the current legislation. The data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth H Graham
- Sociology and Politics, School of Geography, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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62
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Improving neonatal care with the help of veteran resource parents: An overview of current practices. Semin Fetal Neonatal Med 2018; 23:44-51. [PMID: 29111298 DOI: 10.1016/j.siny.2017.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over the past decade, veteran parents who have lived a neonatal intensive care unit (NICU) experience have become increasingly involved as 'resource parents' to provide peer-to-peer support to "new" NICU parents. These parents can provide a unique form of support to new parents. They can also assume other roles in clinical care, research, administration and/or teaching, but those roles are rarely described in the literature. This article reviews many of the activities performed by resource parents in neonatology. These activities were identified/examined and classified according to the location of involvement (hospital or not), the presence/absence of direct interaction with families and providers, and the topic of involvement. We have also identified gaps in knowledge relative to recruitment and training, development and evaluation of programs, structuring of responsibilities, and remuneration of resource parents. Future research is needed to measure the impact of resource parents on neonatal care.
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63
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Antiel RM, Janvier A, Feudtner C, Blaine K, Fry J, Howell LJ, Houtrow AJ. The experience of parents with children with myelomeningocele who underwent prenatal surgery. J Pediatr Rehabil Med 2018; 11:217-225. [PMID: 30507587 DOI: 10.3233/prm-170483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prenatal surgery for myelomeningocele (MMC) has been demonstrated to have benefits over postnatal surgery. Nevertheless, prenatal surgery requires a significant emotional, physical, and financial commitment from the entire family. METHODS Mixed methods study of parents' perceptions regarding provider communication, treatment choices, and the family impact of having a child with MMC. RESULTS Parents of children with MMC (n= 109) completed questionnaires. Parents were well informed and reported gathering information about prenatal surgery from a wide range of sources. After a fetal diagnosis of MMC, most learned about their options from their obstetrician, although one-third were not told about the option of prenatal surgery. About one-fourth of these parents felt pressure to undergo one particular option. Half of parents said that having a child with MMC has had a positive impact on them and their family, while the other half indicated that having a child with MMC has had both positive and negative impacts. The most commonly noted positive impacts were changes in parental attitudes, as well as having new opportunities and relationships. The most frequently reported negative impacts concerned relational and financial strain. The vast majority of parents indicated that they would still undergo prenatal surgery if they could travel back in time with their present knowledge. CONCLUSIONS A better understanding of the parental experiences and perspectives following prenatal surgery will play an important role in providing overall support for parents and family members.
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Affiliation(s)
- Ryan M Antiel
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Annie Janvier
- Department of Pediatrics and Clinical Ethics, University of Montreal, Neonatology, Clinical Ethics, Palliative Care, Sainte-Justine Hospital, and Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jessica Fry
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
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64
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Wallace SE, Gilvary S, Smith MJ, Dolan SM. Parent Perspectives of Support Received from Physicians and/or Genetic Counselors Following a Decision to Continue a Pregnancy with a Prenatal Diagnosis of Trisomy 13/18. J Genet Couns 2017; 27:656-664. [DOI: 10.1007/s10897-017-0168-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022]
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65
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Groen H, Bouman K, Pierini A, Rankin J, Rissmann A, Haeusler M, Yevtushok L, Loane M, Erwich JJHM, de Walle HEK. Stillbirth and neonatal mortality in pregnancies complicated by major congenital anomalies: Findings from a large European cohort. Prenat Diagn 2017; 37:1100-1111. [PMID: 28837248 DOI: 10.1002/pd.5148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide prognostic information to help parents to reach an informed decision about termination or continuation of the pregnancy and to shape peripartum policy based on a large European cohort. METHOD Thirteen registries from the European Surveillance of Congenital Anomalies (EUROCAT) network contributed data from January 1, 1998, to December 31, 2011. Terminations for fetal anomalies were excluded. Chromosomal anomalies, syndromes and isolated anomaly groups were distinguished according to EUROCAT guidelines. Perinatal mortality, stillbirths, and early and late neonatal mortality rates (NMRs) were analyzed by anomaly group and gestational age. RESULTS Among 73 337 cases, perinatal mortality associated with congenital anomaly was 1.27 per 1000 births (95% confidence interval, 1.23-1.31). Average stillbirth rate was 2.68% (range 0%-51.2%). Early and late NMR were 2.75% (range 0%-46.7%) and 0.97% (range 0%-17.9%), respectively. Chromosomal anomalies and syndromes, and most isolated anomalies, had significant differences regarding timing of fetal demise compared to the general population. Chromosomal and central nervous system anomalies had higher term stillbirth rates. CONCLUSIONS We found relevant differences between anomalies regarding rates of stillbirth, NMR, and timing by gestational age. Our data can help parents to decide about their unborn child with a congenital anomaly and help inform maternal-fetal medicine specialists regarding peripartum management.
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Affiliation(s)
- Henk Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Katelijne Bouman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Haeusler
- Department of Obstetrics and Gynecology, Division of Obstetrics and Maternal Fetal Medicine, Medical University of Graz, Graz, Austria
| | - Lyubov Yevtushok
- OMNI-Net for Children and Rivne Medical Diagnostic Center, Rivne, Ukraine
| | - Maria Loane
- Center for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Coleraine, UK
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermien E K de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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66
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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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Lou S, Jensen LG, Petersen OB, Vogel I, Hvidman L, Møller A, Nielsen CP. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies. Prenat Diagn 2017; 37:731-743. [DOI: 10.1002/pd.5093] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/24/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
| | - Lotte Groth Jensen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Olav Bjørn Petersen
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ida Vogel
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Møller
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Department of Public Health; Aarhus University; Aarhus Denmark
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Severe Fetal Abnormality and Outcomes of Continued Pregnancies: A French Multicenter Retrospective Study. Matern Child Health J 2017; 21:1901-1910. [DOI: 10.1007/s10995-017-2305-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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69
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Arthur JD, Gupta D. “You Can Carry the Torch Now:” A Qualitative Analysis of Parents’ Experiences Caring for a Child with Trisomy 13 or 18. HEC Forum 2017; 29:223-240. [DOI: 10.1007/s10730-017-9324-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hudson BF, Oostendorp LJM, Candy B, Vickerstaff V, Jones L, Lakhanpaul M, Bluebond-Langner M, Stone P. The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review. Palliat Med 2017; 31:419-436. [PMID: 27609607 PMCID: PMC5405809 DOI: 10.1177/0269216316663856] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Researchers report difficulties in conducting research with children and young people with life-limiting conditions or life-threatening illnesses and their families. Recruitment is challenged by barriers including ethical, logistical and clinical considerations. AIM To explore how children and young people (aged 0-25 years) with life-limiting conditions or life-threatening illnesses and their families were identified, invited and consented to research published in the last 5 years. DESIGN Systematic review. DATA SOURCES MEDLINE, PsycINFO, Web of Science, Sciences Citation Index and SCOPUS were searched for original English language research published between 2009 and 2014, recruiting children and young people with life-limiting conditions or life-threatening illness and their families. RESULTS A total of 215 studies - 152 qualitative, 54 quantitative and 9 mixed methods - were included. Limited recruitment information but a range of strategies and difficulties were provided. The proportion of eligible participants from those screened could not be calculated in 80% of studies. Recruitment rates could not be calculated in 77%. A total of 31% of studies recruited less than 50% of eligible participants. Reasons given for non-invitation included missing clinical or contact data, or clinician judgements of participant unsuitability. Reasons for non-participation included lack of interest and participants' perceptions of potential burdens. CONCLUSION All stages of recruitment were under reported. Transparency in reporting of participant identification, invitation and consent is needed to enable researchers to understand research implications, bias risk and to whom results apply. Research is needed to explore why consenting participants decide to take part or not and their experiences of research recruitment.
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Affiliation(s)
- Briony F Hudson
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Linda JM Oostendorp
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children’s Palliative Care, UCL Institute of Child Health, London, UK
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, London, UK
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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: 20] [Impact Index Per Article: 2.9] [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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Pennaforte T, Moussa A, Janvier A. Parler de la vie et de la mort en néonatologie : comment optimiser la communication avec les parents ? Arch Pediatr 2017; 24:146-154. [DOI: 10.1016/j.arcped.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 07/06/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
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Wilfond BS. Breaking the Sounds of Silence: Respecting People With Disabilities and Reproductive Decision Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:37-39. [PMID: 27996901 PMCID: PMC7656958 DOI: 10.1080/15265161.2016.1251664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Benjamin S. Wilfond
- University of Washington School of Medicine, Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, Seattle, WA 98101, USA.
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Janvier A, Farlow B, Baardsnes J, Pearce R, Barrington KJ. Measuring and communicating meaningful outcomes in neonatology: A family perspective. Semin Perinatol 2016; 40:571-577. [PMID: 27793420 DOI: 10.1053/j.semperi.2016.09.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medium- and long-term outcomes have been collected and described among survivors of neonatal intensive care units for decades, for a number of purposes: (1) quality control within units, (2) comparisons of outcomes between NICUs, (3) clinical trials (whether an intervention improves outcomes), (4) end-of-life decision-making, (5) to better understand the effects of neonatal conditions and/or interventions on organs and/or long-term health, and finally (6) to better prepare parents for the future. However, the outcomes evaluated have been selected by investigators, based on feasibility, availability, cost, stability, and on what investigators consider to be important. Many of the routinely measured outcomes have major limitations: they may not correlate well with long-term difficulties, they may artificially divide continuous outcomes into dichotomous ones, and may have no clear relationship with quality of life and functioning of children and their families. Several investigations, such as routine term cerebral resonance imaging for preterm infants, have also not yet been shown to improve the outcome of children nor their families. In this article, the most common variables used in neonatology as well as some variables which are rarely measured but may be of equal importance for families are presented. The manner in which these outcomes are communicated to families will be examined, as well as recommendations to optimize communication with parents.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal; Division of Neonatology and centre de recherche, CHU Sainte-Justine, Montréal, Canada; Bureau de l'Éthique Clinique, Université de Montréal, Canada; Unité d'éthique clinique, unité de soins palliatifs, unité de recherche en éthique clinique et partenariat famille, Hôpital Sainte-Justine, Montréal, Canada.
| | - Barbara Farlow
- Parent and patient representative, patients for Patient Safety Canada, Edmonton, Alberta, Canada; The deVeber Institute for Bioethics and Social Research, North York, Ontario Canada
| | - Jason Baardsnes
- Parent representative, Human Health Therapeutics, National Research Council, Montréal, Canada
| | - Rebecca Pearce
- Parent representative, Villa Maria High School, Montreal, Quebec'
| | - Keith J Barrington
- Department of Pediatrics, Université de Montréal; Division of Neonatology and centre de recherche, CHU Sainte-Justine, Montréal, Canada
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Zaal-Schuller IH, Willems DL, Ewals FVPM, van Goudoever JB, de Vos MA. How parents and physicians experience end-of-life decision-making for children with profound intellectual and multiple disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:283-293. [PMID: 27665411 DOI: 10.1016/j.ridd.2016.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND End-of-life decisions (EoLD) often concern children with profound intellectual and multiple disabilities (PIMD). Yet, little is known about how parents and physicians discuss and make these decisions. AIMS The objective of this research was to investigate the experiences of the parents and the involved physician during the end-of-life decision-making (EoLDM) process for children with PIMD. METHODS In a retrospective, qualitative study, we conducted semi-structured interviews with the physicians and parents of 14 children with PIMD for whom an EoLD was made within the past two years. RESULTS A long-lasting relationship appeared to facilitate the EoLDM process, although previous negative healthcare encounters could also lead to distrust. Parents and physicians encountered disagreements during the EoLDM process, but these disagreements could also improve the decision-making process. Most parents, as well as most physicians, considered the parents to be the experts on their child. In making an EoLD, both parents and physicians preferred a shared decision-making approach, although they differed in what they actually meant by this concept. CONCLUSION The EoLDM process for children with PIMD can be improved if physicians are more aware of the specific situation and of the roles and expectations of the parents of children with PIMD.
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Affiliation(s)
- I H Zaal-Schuller
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - D L Willems
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - F V P M Ewals
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Centre Rotterdam, The Netherlands.
| | - J B van Goudoever
- Department of Paediatrics, Emma Children's Hospital - Academic Medical Centre, Amsterdam & Department of Paediatrics, VU University Medical Centre, Amsterdam, The Netherlands.
| | - M A de Vos
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Werner-Lin A, Walser S, Barg FK, Bernhardt BA. “They Can't Find Anything Wrong with Him, Yet
”: Mothers’ experiences of parenting an infant with a prenatally diagnosed copy number variant (CNV). Am J Med Genet A 2016; 173:444-451. [DOI: 10.1002/ajmg.a.38042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/20/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Allison Werner-Lin
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Sarah Walser
- Translational Medicine and Medical Genetics; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Frances K. Barg
- Department of Anthropology and Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Barbara A. Bernhardt
- Translational Medicine and Medical Genetics; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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Pardo Vargas RA, Aracena M, Aravena T, Cares C, Cortés F, Faundes V, Mellado C, Passalacqua C, Sanz P, Castillo Taucher S. [Congenital anomalies of poor prognosis. Genetics Consensus Committee]. ACTA ACUST UNITED AC 2016; 87:422-431. [PMID: 27234469 DOI: 10.1016/j.rchipe.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Genetic Branch of the Chilean Society of Paediatrics, given the draft Law governing the decriminalisation of abortion on three grounds, focusing on the second ground, which considers the "embryo or foetus suffering from a congenital structural anomaly or a genetic disorder incompatible with life outside the womb", met to discuss the scientific evidence according to which congenital anomalies (CA) may be included in this draft law. METHODOLOGY Experts in clinical genetics focused on 10 CA, reviewed the literature evidence, and met to discuss it. RESULTS It was agreed not to use the term "incompatible with life outside the womb", as there are exceptions and longer survivals, and change to "congenital anomaly of poor prognosis (CAPP)". Ten CA were evaluated: serious defects of neural tube closure: anencephaly, iniencephaly and craniorachischisis, pulmonary hypoplasia, acardiac foetus, ectopia cordis, non-mosaic triploidy, "limb body wall" complex, "body stalk" anomaly, trisomy 13, trisomy 18, and bilateral renal agenesis. Findings on the prevalence, natural history, prenatal diagnostic methods, survival, and reported cases of prolonged survival were analysed. Post-natal survival, existence of treatments, and outcomes, as well as natural history without intervention, were taken into account in classifying a CA as a CAPP. CONCLUSION A CAPP would be: anencephaly, severe pulmonary hypoplasia, acardiac foetus, cervical ectopia cordis, non-mosaic triploidy, limb body wall complex, body stalk anomaly, non-mosaic trisomy 13, non-mosaic trisomy 18, and bilateral renal agenesis. For their diagnosis, it is required that all pregnant women have access to assessments by foetal anatomy ultrasound and occasionally MRI, and cytogenetic and molecular testing.
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Affiliation(s)
- Rosa A Pardo Vargas
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile.
| | - Mariana Aracena
- Unidad de Genética, Hospital Luis Calvo Mackenna, Santiago, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Teresa Aravena
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Indisa, Santiago, Chile
| | - Carolina Cares
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Dávila, Santiago, Chile
| | - Fanny Cortés
- Centro de Enfermedades Raras, Clínica Las Condes, Santiago, Chile
| | - Víctor Faundes
- Laboratorio de Genética y Enfermedades Metabólicas, INTA, Universidad de Chile, Santiago, Chile
| | - Cecilia Mellado
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricia Sanz
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Sección Genética, Hospital San Juan de Dios, Santiago, Chile
| | - Silvia Castillo Taucher
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Clínica Alemana, Santiago, Chile
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Denney-Koelsch EM, Côté-Arsenault D, Jenkins Hall W. Feeling Cared For Versus Experiencing Added Burden: Parents' Interactions With Health-Care Providers in Pregnancy With a Lethal Fetal Diagnosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1054137316665817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reports on parental responses to and needs from health-care providers during pregnancy with a lethal fetal diagnosis (LFD). Sixteen mothers and 14 partners participated in a longitudinal, phenomenological study of continuing a pregnancy with an LFD. During individual and joint couple interviews conducted during pregnancy and postpartum, parents described numerous health-care interactions throughout pregnancy. From the participants' words, Categories of the Content, Process, and Outcome of these interactions emerged. They sought health care for the Content (information and expert guidance), but they desired providers who maintain hope, were caring and nonjudgmental, used a straightforward manner, and showed sensitivity to their developmental journey ( Process). They also desired health-care systems that provided continuity of care and minimized waiting times ( Process). We propose data-based recommendations for health-care providers to address the two identified opposing Outcomes: Feeling Cared For and Experiencing Added Burden.
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Affiliation(s)
- Erin M. Denney-Koelsch
- Division of Palliative Care, University of Rochester School of Medicine & Dentistry, NY, USA
| | | | - Wendasha Jenkins Hall
- Department of Public Health Education, University of North Carolina at Greensboro, NC, USA
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Tosello B. Soins palliatifs périnatals en France : pour qui ? Pourquoi ? Comment ? Arch Pediatr 2016; 23:983-9. [DOI: 10.1016/j.arcped.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 06/16/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Janvier A, Farlow B, Barrington KJ. Parental hopes, interventions, and survival of neonates with trisomy 13 and trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:279-87. [DOI: 10.1002/ajmg.c.31526] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Donovan JH, Krigbaum G, Bruns DA. Medical interventions and survival by gender of children with trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:272-8. [DOI: 10.1002/ajmg.c.31522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lawson AK, Zweifel JE, Klock SC. Blurring the line between life and death: a review of the psychological and ethical concerns related to posthumous-assisted reproduction. EUR J CONTRACEP REPR 2016; 21:339-46. [PMID: 27388465 DOI: 10.1080/13625187.2016.1203892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Posthumous-assisted reproduction (PAR), though viewed unfavourably by some, is desirable to many individuals whose partners die prior to the completion of family building. PAR is technically feasible for males and females both pre- and post-mortem and these procedures have previously been completed on numerous occasions. However, such treatment is associated with three primary ethical concerns: autonomy; beneficence; and justice for the living, the deceased, and the soon-to-be conceived. Further, there are many psychological risks of PAR which may affect all involved parties. As such, early psychological counselling of patients and surviving family members is warranted.
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Affiliation(s)
- Angela K Lawson
- a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Julianne E Zweifel
- b Reproductive Endocrinology and Infertility Clinic, Department of Obstetrics and Gynecology , University of Wisconsin-Madison , Madison , WI , USA
| | - Susan C Klock
- a Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
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Abstract
Clinicians need to provide accurate, up-to-date, and balanced information to parents following a prenatal or postnatal diagnosis of Down syndrome and other genetic conditions. Families want information about the genomic outcomes and medical issues, but they also want information about life outcomes and social supports. Because the anticipated outcomes of a condition can change significantly based on available social support, health care, and services, it is important for clinicians to stay up-to-date about new developments and credible, medically reviewed information about Down syndrome and other genetic conditions to access resources for clinical care.
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Affiliation(s)
- Robert A Saul
- Children's Hospital, Greenville Health System-General Pediatrics, Greenville, SC
| | - Stephanie Hall Meredith
- National Center for Prenatal and Postnatal Resources, Human Development Institute, University of Kentucky, Lexington, KY
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Neonatal Death in the Emergency Department: When End-of-Life Care Is Needed at the Beginning of Life. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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86
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Iltis AS. Prenatal screening and prenatal diagnosis: contemporary practices in light of the past. JOURNAL OF MEDICAL ETHICS 2016; 42:334-339. [PMID: 27161556 DOI: 10.1136/medethics-2016-103623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The 20th century eugenics movement in the USA and contemporary practices involving prenatal screening (PNS), prenatal diagnosis (PND), abortion and preimplantation genetic diagnosis (PGD) share important morally relevant similarities. I summarise some features of the 20th century eugenics movement; describe the contemporary standard of care in the USA regarding PNS, PND, abortion and PGD; and demonstrate that the 'old eugenics' the contemporary standard of care share the underlying view that social resources should be invested to prevent the birth of people with certain characteristics. This comparison makes evident the difficulty of crafting moral arguments that treat some uses of PNS, PND, abortion and PGD as licit and others as illicit.
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Abstract
The objective is to examine whether cardiac surgery should be considered for children with trisomy 13 or 18 (T13 or 18).T13 or 18 were previously referred to as "lethal" conditions due to high mortality rates and severe disability among survivors. In the last decade, investigations have revealed these conditions are heterogeneous, with increasing numbers of studies describing interventions for these children. A number of factors makes the interpretation of reported outcomes after cardiac surgery challenging: (1) dissimilarities in practice lead to a wide variation in reported outcomes after cardiac surgery; (2) cardiac surgery is generally offered to older, healthier children; (3) cardiac surgeries of widely varying risks are often lumped together in individual studies, and (4) cases where cardiac surgery has been withheld are generally not included in publications. It is unclear whether withholding cardiac surgery for some children with a ventricular septal defect will lead to death, or the development of pulmonary hypertension, or if death will occur from other causes. In this article, we describe two children with different clinical situations and examine whether cardiac surgery would benefit them and how to communicate with their families. Cardiac surgery may be beneficial to some children with trisomy 13 or 18, but may harm others. Every child should be approached in an individual fashion and the goals of each family should be addressed. Children who are more likely to benefit from surgery may be older, healthier children without respiratory support. Rigorous and transparent research is needed to identify factors that affect survival in trisomy 13 or 18.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, University of Montreal, Montreal, Canada; Unité d'éthique clinique, Hôpital Sainte-Justine, Quebec, Canada; Research Center, Hôpital Sainte-Justine, Quebec, Canada.
| | - Barbara Farlow
- The DeVeber Institute for Bioethics and Social Research, Ontario, Canada; Patients for Patient Safety, Ontario, Canada
| | - Keith Barrington
- Department of Pediatrics, University of Montreal, Montreal, Canada; Research Center, Hôpital Sainte-Justine, Quebec, Canada
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88
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Tosello B, Haddad G, Gire C, Einaudi MA. Lethal fetal abnormalities: how to approach perinatal palliative care? J Matern Fetal Neonatal Med 2016; 30:755-758. [PMID: 27150239 DOI: 10.1080/14767058.2016.1186633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Some of the antenatally diagnosed fetal pathologies are unlikely to get compatible with life. Still some women choose to continue with pregnancy. Subsequently, perinatal palliative care (PPC) has become a constructive demarche in such situations. Our study, based on a multicentric survey, reports some cases of fetal pathologies considered as lethal according to perinatal professionals and reveals the decisional process in each case. METHODS We sent by emails a questionnaire to 434 maternal-fetal medicine specialists and fetal care pediatric specialists at 48 multidisciplinary centers for prenatal diagnosis. RESULTS The participation rate was 49.3%. In total, 61 obstetric-gynecologists and 68 neonatologists completed the survey. The results showed that 35.4% of the pregnant women asked for the continuation of pregnancy and 24.7% asked for the termination of pregnancy. More than half of professionals (52.9%) took the initiative of informing women about the options for birth support (including PPC), while 32.7% of obstetric gynecologists did not take this initiative versus 10.2% of neonatologists (p < 0.01). CONCLUSION This study demonstrates the absolute need to provide PPC training for professionals and to standardize its practices.
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Affiliation(s)
- Barthélémy Tosello
- a Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen, Hospital La Timone , Marseille , France and.,b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Grace Haddad
- b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Catherine Gire
- b Department of Neonatology , Assistance Publique-Hôpitaux De Marseille, Hospital Nord , Marseille , France
| | - Marie-Ange Einaudi
- a Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen, Hospital La Timone , Marseille , France and
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89
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Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18. Obstet Gynecol Surv 2016; 71:295-300. [DOI: 10.1097/ogx.0000000000000304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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90
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Zaal-Schuller IH, de Vos MA, Ewals FVPM, van Goudoever JB, Willems DL. End-of-life decision-making for children with severe developmental disabilities: The parental perspective. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:235-246. [PMID: 26741261 DOI: 10.1016/j.ridd.2015.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 11/28/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIMS The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. METHODS AND PROCEDURES We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. OUTCOMES AND RESULTS We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. CONCLUSIONS AND IMPLICATIONS Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team.
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Affiliation(s)
- I H Zaal-Schuller
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M A de Vos
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - F V P M Ewals
- Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - J B van Goudoever
- Department of Paediatrics, Emma Children's Hospital-Academic Medical Centre, Amsterdam & Department of Paediatrics, VU University Medical Centre, Amsterdam, The Netherlands.
| | - D L Willems
- Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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91
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Janvier A, Farlow B. The ethics of neonatal research: An ethicist's and a parents' perspective. Semin Fetal Neonatal Med 2015; 20:436-41. [PMID: 26497942 DOI: 10.1016/j.siny.2015.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The ethics of neonatal research are complex because vulnerable new parents are asked to provide consent on behalf of their fragile baby. Whereas clinical neonatal care has evolved to value personalized and shared decision-making, the goal of research ethics is still to standardize the informed consent process and make it as complete and thorough as possible. Ethicists, lawyers and physicians have shaped the field of research ethics and consent for research. The goal of detailed informed consent is to protect participants from harm, but procedures were developed without input from the principal stakeholders: ex-neonatal intensive care unit parents/patients. Empirical investigations examining patient and parental perspectives on research and research ethics are lacking. Rigorous investigations are needed to determine how parents of sick neonates want their families to be protected, knowing that a lack of research is also harmful. Large randomized controlled multicenter trials will always be needed to improve neonatal outcomes. These trials are costly and time-consuming. Currently, the way in which research is funded and regulated and the way in which academic merit is recognized lead to inefficiency and a waste of precious resources. Following a review of the history of research ethics, this article examines and discusses the ethics of research in neonatology. In addition, challenges and opportunities are identified and ideas for future investigations are proposed.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics and Clinical Ethics, University of Montreal, Montreal, Canada; Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada.
| | - Barbara Farlow
- The DeVeber Institute for Bioethics and Social Research, North York, Ontario, Canada; Patients for Patient Safety Canada, Canadian Patient Safety Institute, Canada
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92
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Imai K, Uchiyama A, Okamura T, Ago M, Suenaga H, Sugita E, Ono H, Shuri K, Masumoto K, Totsu S, Nakanishi H, Kusuda S. Differences in mortality and morbidity according to gestational ages and birth weights in infants with trisomy 18. Am J Med Genet A 2015; 167A:2610-7. [PMID: 26307940 PMCID: PMC5049630 DOI: 10.1002/ajmg.a.37246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 06/24/2015] [Indexed: 12/03/2022]
Abstract
The aim of this study was to clarify the effects of gestational age and birth weight on outcomes of the infants. Medical records of 36 infants with trisomy 18 admitted to Tokyo Women's Medical University Hospital from 1991 to 2012 were reviewed retrospectively. We compared clinical characteristics between term infants (n = 15) and preterm infants (n = 21). There were one very-low-birth-weight (VLBW) term infant (5%) and 12 VLBW preterm infants (80%). Although there were no significant differences in clinical characteristics and provided management between the two groups, none of the preterm infants achieved survival to discharge. On the other hand, 6 of 21 term infants (29%) achieved survival to discharge (P < 0.05). Similar results were obtained for comparisons between the VLBW infants and non-VLBW infants. Multiple logistic regression analysis revealed that shorter gestational age had a more negative impact than lower birth weight to survival to discharge in infants with trisomy 18. In both preterm and term groups, the infants who died before 30 days commonly died of respiratory failure or apnea. Whereas, the infants who survived more than 30 days mostly died of heart failure.
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Affiliation(s)
- Ken Imai
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Atsushi Uchiyama
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Tomoka Okamura
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Mako Ago
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Hideyo Suenaga
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Eri Sugita
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Hideko Ono
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Kyoko Shuri
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Kenichi Masumoto
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Satsuki Totsu
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Hidehiko Nakanishi
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal CenterTokyo Women's Medical UniversityTokyoJapan
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93
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Russo FM, Pozzi E, Verderio M, Bernasconi DP, Giardini V, Colombo C, Maitz S, Vergani P. Parental counseling in trisomy 18: Novel insights in prenatal features and postnatal survival. Am J Med Genet A 2015; 170A:329-336. [PMID: 26473304 DOI: 10.1002/ajmg.a.37424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/21/2015] [Indexed: 12/23/2022]
Abstract
Data on the outcome of trisomy T18 (T18) when diagnosed during pregnancy are lacking. We performed a retrospective study of pregnancies complicated by T18 diagnosed at our center and a literature search for publications on the topic, with pooled estimates of survival rates at different gestational and post-natal ages. In our series, all the 60 patients included in the analysis had prenatally detected ultrasound anomalies, which were evidenced in the first trimester or at the second trimester scan in 73% of cases. In the continued pregnancies, ultrasound findings did not correlate with prenatal or post-natal outcome. A meta-analysis of available literature and our data showed that 48% [37-60%] of fetuses were live born, and among these 39% [11-72%] survived beyond 48 hr and 11% [3-21%] beyond 1 month. Our results confirm that prenatal ultrasound has high sensitivity in detection of T18 but is not predictive of the outcome of the continued pregnancies. The data on survival support that T18, even when antenatally diagnosed, cannot be considered as a uniformly lethal syndrome.
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Affiliation(s)
- Francesca M Russo
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | - Elisa Pozzi
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | - Maria Verderio
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | | | - Valentina Giardini
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | - Carla Colombo
- Department of Neonatology and Neonatal Intensive Care Unit, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | - Silvia Maitz
- Department of Genetics, Fondazione MBBM, AO S. Gerardo, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, AO S. Gerardo, Monza, Italy
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94
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Edvardsson K, Mogren I, Lalos A, Persson M, Small R. A routine tool with far-reaching influence: Australian midwives' views on the use of ultrasound during pregnancy. BMC Pregnancy Childbirth 2015; 15:195. [PMID: 26311437 PMCID: PMC4551225 DOI: 10.1186/s12884-015-0632-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/21/2015] [Indexed: 11/21/2022] Open
Abstract
Background Ultrasound is a tool of increasing importance in maternity care. Midwives have a central position in the care of pregnant women. However, studies regarding their experiences of the use of ultrasound in this context are limited. The purpose of this study was to explore Australian midwives’ experiences and views of the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and situations where maternal and fetal health interests conflict. Methods A qualitative study was undertaken in Victoria, Australia in 2012, based on six focus group discussions with midwives (n = 37) working in antenatal and intrapartum care, as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis. Results One overarching theme emerged from the analysis: Obstetric ultrasound – a routine tool with far-reaching influence, and it was built on three categories. First, the category‘Experiencing pros and cons of ultrasound’ highlighted that ultrasound was seen as having many advantages; however, it was also seen as contributing to increased medicalisation of pregnancy, to complex and sometimes uncertain decision-making and to parental anxiety. Second, ‘Viewing ultrasound as a normalised and unquestioned examination’ illuminated how the use of ultrasound has become normalised and unquestioned in health care and in wider society. Midwives were concerned that this impacts negatively on informed consent processes, and at a societal level, to threaten acceptance of human variation and disability. Third, ‘Reflecting on the fetus as a person in relation to the pregnant woman’ described views on that ultrasound has led to increased ‘personification’ of the fetus, and that women often put fetal health interests ahead of their own. Conclusions The results reflect the significant influence ultrasound has had in maternity care and highlights ethical and professional challenges that midwives face in their daily working lives concerning its use. Further discussion about the use of ultrasound is needed, both among health professionals and in the community, in order to protect women’s rights to informed decision-making and autonomy in pregnancy and childbirth and to curb unnecessary medicalisation of pregnancy. Midwives’ experiences and views play an essential role in such discussions.
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Affiliation(s)
- Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 87, Umeå, Sweden. .,Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, Vic, 3000, Australia.
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 87, Umeå, Sweden.
| | - Ann Lalos
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE 901 87, Umeå, Sweden.
| | | | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, Vic, 3000, Australia.
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95
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Minear MA, Alessi S, Allyse M, Michie M, Chandrasekharan S. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues. Annu Rev Genomics Hum Genet 2015; 16:369-98. [DOI: 10.1146/annurev-genom-090314-050000] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mollie A. Minear
- Duke Science & Society, Duke University, Durham, North Carolina 27708
| | - Stephanie Alessi
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California 94305
| | - Megan Allyse
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota 55905
| | - Marsha Michie
- Institute for Health and Aging, University of California, San Francisco, California 94143
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96
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Abstract
BACKGROUND Trisomy 13, also known as Patau syndrome, occurs in 1/10,000 live births. Trisomy 13 is traditionally considered "lethal" with death as an outcome to be expected quickly. With regard to treatment decisions, families may feel that they are being judged by the medical community and their perception of quality of life. PURPOSE This case describes an intrauterine growth restricted preterm female presenting with multiple dysmorphic features. METHODS Using a case description as an example, the use of palliative care and alternative approaches to caregiving with the family of an infant with Trisomy 13 are explored. FINDINGS/RESULTS A definitive diagnosis of trisomy 13 was made and discussed with the family at day 4 of life. Palliative care was initially used along with life-extending care. IMPLICATIONS FOR PRACTICE With progression of the disease palliative care comes more to the forefront to help relieve physical and emotional suffering for not only the infant but the family, too. Offering nontraditional opportunities can help create a legacy and allow the families to know that their baby's life had meaning. IMPLICATIONS FOR RESEARCH Providing caregiver information on the diagnosis and specialized palliative care may improve infant and family outcomes.
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98
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Wilkinson D, de Crespigny L, Xafis V. Ethical language and decision-making for prenatally diagnosed lethal malformations. Semin Fetal Neonatal Med 2014; 19:306-11. [PMID: 25200733 PMCID: PMC4339700 DOI: 10.1016/j.siny.2014.08.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In clinical practice, and in the medical literature, severe congenital malformations such as trisomy 18, anencephaly, and renal agenesis are frequently referred to as 'lethal' or as 'incompatible with life'. However, there is no agreement about a definition of lethal malformations, nor which conditions should be included in this category. Review of outcomes for malformations commonly designated 'lethal' reveals that prolonged survival is possible, even if rare. This article analyses the concept of lethal malformations and compares it to the problematic concept of 'futility'. We recommend avoiding the term 'lethal' and suggest that counseling should focus on salient prognostic features instead. For conditions with a high chance of early death or profound impairment in survivors despite treatment, perinatal and neonatal palliative care would be ethical. However, active obstetric and neonatal management, if desired, may also sometimes be appropriate.
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Affiliation(s)
- Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Lachlan de Crespigny
- Department of Obstetrics and Gynaecology, University of Melbourne, Blairgowrie, Victoria, Australia
| | - Vicki Xafis
- Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
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99
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Janvier A, Farlow B. Arrogance-based medicine: guidelines regarding genetic testing in children. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:15-16. [PMID: 24592831 DOI: 10.1080/15265161.2013.879951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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