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Samples S, Gandhi R, Woo J, Patel A. Ethical Considerations in Fetal Cardiology. J Cardiovasc Dev Dis 2024; 11:172. [PMID: 38921672 PMCID: PMC11204861 DOI: 10.3390/jcdd11060172] [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: 04/16/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
Fetal cardiology has evolved over the last 40 years and changed the timing of diagnosis and counseling of congenital heart disease, decision-making, planning for treatment at birth, and predicting future surgery from the postnatal to the prenatal period. Ethical issues in fetal cardiology transect multiple aspects of biomedical ethics including improvement in prenatal detection and diagnostic capabilities, access to equitable comprehensive care that preserves a pregnant person's right to make decisions, access to all reproductive options, informed consent, complexity in shared decision-making, and appropriate use of fetal cardiac interventions. This paper first reviews the literature and then provides an ethical analysis of accurate and timely diagnosis, equitable delivery of care, prenatal counseling and shared decision-making, and innovation through in utero intervention.
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Affiliation(s)
- Stefani Samples
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Rupali Gandhi
- Division of Pediatric Cardiology, Advocate Christ Children’s Hospital, Oak Lawn, IL 60453, USA
- Section of Cardiology, Department of Pediatrics, Comer Children’s Hospital, University of Chicago, Chicago, IL 60637, USA
| | - Joyce Woo
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Angira Patel
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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McKechnie AC, Elgersma KM, Ambrose MB, Sanchez Mejia AA, Shah KM, Iwaszko Wagner T, Trebilcock A, Hallock C. Nurse-guided Mobile Health Care Program to Reduce Emotional Distress Experienced by Parents of Infants Prenatally Diagnosed with Critical Congenital Heart Disease: A Pilot Study. PROGRESS IN PEDIATRIC CARDIOLOGY 2024; 72:101687. [PMID: 38130374 PMCID: PMC10732467 DOI: 10.1016/j.ppedcard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Following prenatal diagnosis of critical congenital heart disease (CCHD), parents encounter emotional distress while facing caregiving challenges. Supportive psycho-educational interventions using mobile health (mHealth) can make care more accessible. Objectives We tested a novel nurse-guided mHealth care program, Preparing Heart and Mind™ (PHM™), with the objectives of examining feasibility and estimating the effect of the intervention on parents' emotional distress. Methods This pilot study design randomized participants using a 2:1 intervention to control ratio. Analysis involved description of retention, and intervention attendance and engagement, and adjusted linear mixed models to estimate group differences in depressive (CES-D), anxiety (STAI-S), and traumatic stress (IES-r) symptoms. Results The sample included 55 parents (n=38 PHM™ group, n=17 control). Complete retention of 37 (67%) parents included 29 (76%) in the PHM™ group and 8 (47%) control. Most attrition was due to infant death (7 parents), transplant referral (2 parents), or postnatal diagnostic ineligibility (4 parents). For the PHM™ group, ≥96% of parents attended pre- and postnatal sessions and most (65%) messaged with the nurse. mHealth engagement was highest prenatally, with handling uncertainty the most viewed topic (average 94% pages viewed). In linear mixed models analyses, the PHM™ group had on average 4.84 points lower depression (95% CI: -10.68-1.04), 6.56 points lower anxiety (-14.04-0.92), and 6.28 points lower trauma (-14.44-1.88) scores by study end. Conclusion Findings suggest that a nurse-guided mHealth approach is feasible and may contribute to a clinically important reduction in parents' emotional distress.
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Affiliation(s)
- Anne Chevalier McKechnie
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Kristin M Elgersma
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Matthew B Ambrose
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Aura A Sanchez Mejia
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030
- Texas Children's Hospital Maternal-Fetal Medicine, 6651 Main Street, Houston, TX 77030
| | - Kavisha M Shah
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Taylor Iwaszko Wagner
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Anna Trebilcock
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Carrie Hallock
- GetWell, 7700 Old Georgetown Rd., 4th Floor, Bethesda, MD 20814
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Sood E, Canter KS, Battisti S, Nees SN, Srivastava S, Munoz Osorio A, Feinson J, Gallo A, Jung S, Riegel E, Ng S, Kazak AE. User-Centered Development of HEARTPrep, a Digital Health Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease. J Patient Exp 2024; 11:23743735241229374. [PMID: 38414756 PMCID: PMC10898312 DOI: 10.1177/23743735241229374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
User-centered models for the development of digital health interventions are not consistently applied in healthcare settings. This study used a five-phase, user-centered approach to develop HEARTPrep©, a psychosocial intervention delivered via mobile app and telehealth to mothers expecting a baby with congenital heart disease (CHD) to promote maternal, family, and child well-being. Phases of intervention development were: (I) establishing partnerships; (II) creating content; (III) developing prototype and testable intervention; (IV) conducting think-aloud testing; and (V) completing beta testing. Partnerships with parents, clinicians, and design/technology experts were integral throughout the development of HEARTPrep©. Parents of children with CHD also served as participants in Phases II-V, contributing to the creation of content and providing feedback to inform the iterative refinement of HEARTPrep©. These five phases produced a refined digital health intervention with promising feasibility, usability, and acceptability results. This user-centered approach can be used to develop digital health interventions targeting various health outcomes.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kimberly S. Canter
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven Battisti
- Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Shannon N. Nees
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shubhika Srivastava
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Angel Munoz Osorio
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
| | - Judith Feinson
- Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Adrienne Gallo
- Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Sean Jung
- Center for Health Delivery Innovation, Nemours Children's Health, Wilmington, DE, USA
| | - Erin Riegel
- Conquering CHD-Delaware, Wilmington, DE, USA
| | - Stephanie Ng
- Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE, USA
| | - Anne E. Kazak
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Rodrigues MG, Rodrigues JD, Moreira JA, Clemente F, Dias CC, Azevedo LF, Rodrigues PP, Areias JC, Areias ME. A randomized controlled trial to assess the impact of psychoeducation on the quality of life of parents with children with congenital heart defects-Quantitative component. Child Care Health Dev 2024; 50:e13199. [PMID: 37967565 DOI: 10.1111/cch.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/30/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns. METHODS Participants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. RESULTS Parents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups. CONCLUSIONS The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.
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Affiliation(s)
- Marisa Garcia Rodrigues
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - José Daniel Rodrigues
- Center for Health Technology and Services Research (CINTESIS) - EvidenS&HTA, FMUP, Porto, Portugal
| | - Jorge Antunes Moreira
- Department of Pediatric Cardiology, University Hospital Center of São João (CHUSJ), Porto, Portugal
| | - Fátima Clemente
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
- Neonatal Intensive Care Unit, Neonatology Department, CHUSJ, Porto, Portugal
- São João Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Training Center, CHUSJ, Porto, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), FMUP, Porto, Portugal
- RISE@CINTESIS, FMUP, Porto, Portugal
| | - Luís Filipe Azevedo
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Clinical and Health Services Research (PDICSS), FMUP, Porto, Portugal
| | - Pedro Pereira Rodrigues
- RISE@CINTESIS, FMUP, Porto, Portugal
- Department of Community Medicine, MEDCIDS, FMUP, Porto, Portugal
- Health Data Science (PDCDS), FMUP, Porto, Portugal
| | | | - Maria Emília Areias
- Cardiovascular R&D Unit (UnIC), FMUP, Porto, Portugal
- University Institute of Health Sciences (IUCS), Gandra, Portugal
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