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Bonnot Fazio S, Dany L, Dahan S, Tosello B. Communication, information, and the parent–caregiver relationship in neonatal intensive care units: A review of the literature. Arch Pediatr 2022; 29:331-339. [DOI: 10.1016/j.arcped.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/15/2021] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
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Piette V, Dombrecht L, Deliens L, Cools F, Chambaere K, Goossens L, Naulaers G, Laroche S, Cornette L, Bekaert E, Decoster P, Beernaert K, Cohen J. Barriers and facilitators for parents in end-of-life decision-making for neonates at the Neonatal Intensive Care Unit: A qualitative study. Palliat Med 2022; 36:730-741. [PMID: 35152797 DOI: 10.1177/02692163221076365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mortality and end-of-life decision-making can occur in newborns, especially within the Neonatal Intensive Care Unit. For parents, participating in end-of-life decision-making is taxing. Knowledge is lacking on what support is helpful to parents during decision-making. AIM To identify barriers and facilitators experienced by parents in making an end-of-life decision for their infant. DESIGN Qualitative study using face-to-face semi-structured interviews. SETTING/PARTICIPANTS We interviewed 23 parents with a child that died after an end-of-life decision at a Neonatal Intensive Care Unit between April and September 2018. RESULTS Parents stated barriers and facilitators within 4 themes: 1. Clinical knowledge and prognosis; 2. Quality of information provision; 3. Emotion regulation; and 4. Psychosocial environment. Facilitators include knowing whether the prognosis includes long-term negative quality of life, knowing all treatment options, receiving information according to health literacy level, being able to process intense emotions, having experienced counseling and practical help. Barriers include a lack of general medical knowledge, being unprepared for a poor prognosis, having an uninformed psychologist. CONCLUSIONS We found that clinical information and psychosocial support aid parents in decision-making. Information is best tailored to health literacy. Psychosocial support can be provided by experienced, informed counselors, social services and sibling support, distinguishing between verbal and non-verbal coping preferences, and calm, familiar architecture. Intense emotions may hinder absorption of clinical information, therefore interventions to aid emotion regulation and reduce cognitive load may be looked at in further research. Adjustment of the Situations, Opinions and Options, Parents, Information, Emotions framework based on our results can be evaluated.
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Affiliation(s)
- Veerle Piette
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Laure Dombrecht
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Filip Cools
- Department of Neonatology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Linde Goossens
- Department of Neonatology, Ghent University Hospital, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven
| | - Sabine Laroche
- Department of Neonatology, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Luc Cornette
- Department of Neonatology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Eline Bekaert
- Research Department Belgian Poison Centre, Brussels, Belgium
| | - Pauline Decoster
- Department of Maternity, AZ Sint-Jan Brugge-Oostende, Oostende, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
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Pirrello J, Sorin G, Dahan S, Michel F, Dany L, Tosello B. Analysis of communication and logistic processes in neonatal intensive care unit. BMC Pediatr 2022; 22:137. [PMID: 35291967 PMCID: PMC8922841 DOI: 10.1186/s12887-022-03209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In neonatology, parents play a central role as guarantors of the new-born's autonomy. Notifying parents about their infant's status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team. The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions. METHODS This qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone. RESULTS The verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences. CONCLUSION Physician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.
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Affiliation(s)
- J Pirrello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - G Sorin
- Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - S Dahan
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - F Michel
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Pediatric Intensive Care Unit, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - L Dany
- Aix Marseille University, LPS, Aix-en-Provence, France.,Service of Medical Oncology, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - B Tosello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France. .,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France.
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Garten L, Globisch M, von der Hude K, Jäkel K, Knochel K, Krones T, Nicin T, Offermann F, Schindler M, Schneider U, Schubert B, Strahleck T. Palliative Care and Grief Counseling in Peri- and Neonatology: Recommendations From the German PaluTiN Group. Front Pediatr 2020; 8:67. [PMID: 32181234 PMCID: PMC7058113 DOI: 10.3389/fped.2020.00067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/11/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Lars Garten
- Department of Neonatology, Palliative Neonatology Team, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel Globisch
- Department for Content and Development, German Children's Hospice Association, Olpe, Germany
| | - Kerstin von der Hude
- Department of Neonatology, Palliative Neonatology Team, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Jäkel
- Association of Premature and At-Risk Born Children, Regional group of Rhineland-Palatinate, Mainz, Germany
| | - Kathrin Knochel
- Center for Pediatric Palliative Care, University Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tanja Krones
- University Hospital Zürich/Institute of Biomedical Ethics and History of Medicine, University of Zürich, Zurich, Switzerland
| | - Tatjana Nicin
- Department of Obstetrics, Klinikum Hanau, Hanau, Germany
| | - Franziska Offermann
- Federal Association of Orphaned Parents and Mourning Siblings in Germany, Leipzig, Germany
| | - Monika Schindler
- Department of Neonatology and Paediatric Intensive Care, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Uwe Schneider
- Department of Obstetrics, Universitätsklinikum Jena, Jena, Germany
| | - Beatrix Schubert
- Roman-Catholic Diocese of Rottenburg-Stuttgart, Department Pastoral Care in Health Care, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Strahleck
- Department of Neonatology and Neonatal Intensive Care, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
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Aujoulat I, Henrard S, Charon A, Johansson AB, Langhendries JP, Mostaert A, Vermeylen D, Verellen G. End-of-life decisions and practices for very preterm infants in the Wallonia-Brussels Federation of Belgium. BMC Pediatr 2018; 18:206. [PMID: 29945564 PMCID: PMC6020374 DOI: 10.1186/s12887-018-1168-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/05/2018] [Indexed: 11/26/2022] Open
Abstract
Background Very preterm birth (24 to < 32 week’s gestation) is a major public health issue due to its prevalence, the clinical and ethical questions it raises and the associated costs. It raises two major clinical and ethical dilemma: (i) during the perinatal period, whether or not to actively manage a baby born very prematurely and (ii) during the postnatal period, whether or not to continue a curative treatment plan initiated at birth. The Wallonia-Brussels Federation in Belgium counts 11 neonatal intensive care units. Methods An inventory of key practices was compiled on the basis of an online questionnaire that was sent to the 65 neonatologists working in these units. The questionnaire investigated care-related decisions and practices during the antenatal, perinatal and postnatal periods, as well as personal opinions on the possibility of standardising and/or legislating for end-of-life decisions and practices. The participation rate was 89% (n = 58). Results The results show a high level of homogeneity pointing to overall agreement on the main principles governing curative practice and the gestational age that can be actively managed given the current state of knowledge. There was, however, greater diversity regarding principles governing the transition to end-of-life care, as well as opinions about the need for a common protocol or law to govern such practices. Conclusion Our results reflect the uncertainty inherent in the complex and diverse situations that are encountered in this extreme area of clinical practice, and call for qualitative research and expert debates to further document and make recommendations for best practices regarding several “gray zones” of end-of-life care in neonatology, so that high quality palliative care may be granted to all neonates concerned with end-of-life decisions. Electronic supplementary material The online version of this article (10.1186/s12887-018-1168-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabelle Aujoulat
- Université catholique de Louvain (UCL), Institute of Health and Society (IRSS), Clos chapelle-aux-champs, n° 30.14 - 1200, Brussels, Belgium.
| | - Séverine Henrard
- Université catholique de Louvain (UCL), Institute of Health and Society (IRSS), Clos chapelle-aux-champs, n° 30.14 - 1200, Brussels, Belgium
| | - Anne Charon
- Grand Hôpital de Charleroi (GHC), Charleroi, Belgium
| | | | | | - Anne Mostaert
- Centre hospitalier régional (CHR) de Namur, Namur, Belgium
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Wool C, Kain VJ, Mendes J, Carter BS. Quality predictors of parental satisfaction after birth of infants with life-limiting conditions. Acta Paediatr 2018; 107:276-282. [PMID: 28695618 DOI: 10.1111/apa.13980] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/27/2022]
Abstract
AIM This study examines parental satisfaction with care received in the context of a life-limiting foetal diagnosis and subsequent birth. METHODS Survey methods were utilised to embed the Quality Indicators (QI) and Parental Satisfaction of Perinatal Palliative Care Instrument in a survey: 'The Voice of Parents'. RESULTS The web-based survey had a final sample of N = 405 parent responders. Overall, parents reported satisfaction with care (80.2%; n = 393). Parents satisfied with care reported higher agreement with quality indicator items for all subscales. In total, 17 items from the 41-item instrument revealed the ability to predict higher parental satisfaction when particular QI are reported. CONCLUSION This study has led to credible insights into parental satisfaction with care given after the birth of an infant with a life-limiting condition. The findings contribute to development of a model with a good fit in ascertaining the importance of compassion, unhurried provider-patient communication and bereavement interventions.
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Affiliation(s)
- Charlotte Wool
- Department of Nursing; York College of Pennsylvania; York PA USA
| | - Victoria J. Kain
- Griffith University and Menzies Health Institute; Brisbane QLD Australia
| | | | - Brian S. Carter
- University of Missouri-Kansas City School of Medicine; Kansas City MO USA
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Abstract
PURPOSE In neonates, the course of illness is often unpredictable and symptom assessment is difficult. This is even truer at the end of life (EOL). Time to death can take minutes to days, and ongoing management of the infant is needed during the time between discontinuation of life-sustaining treatment and death to ensure that the infant remains free of pain and suffering. The symptoms experienced by neonates as they die, as well as best ways to treat those symptoms, are understudied. The purpose of this study was to examine symptoms exhibited by neonates at the EOL and the treatments used to manage those symptoms as documented in the medical record during the last 24 hours of life. SUBJECTS The sample included 20 neonates who died at a large children's hospital. DESIGN This was an exploratory, descriptive study. METHODS Descriptive data, such as diagnosis, ongoing therapy at time of treatment withdrawal or withholding, pharmacologic and nonpharmacologic interventions associated with treatment withdrawal, time of treatment withdrawal and death, age at time of death, signs and symptoms exhibited during EOL care, and pain scores, were abstracted from the infant's medical record. MAIN OUTCOME MEASURES Inadequate documentation in the medical record resulted in missing data that made it not possible to fully explore aspects of symptom management during the last 24 hours of life; however, some important results were found. RESULTS This study showed a difference in the way neonates approach the EOL period. Other findings were that most infants in the study received pain medication, even though pain scores were infrequently documented and drug dosages varied across infants. Finally, documentation of nonpharmacologic interventions utilized at the EOL was also lacking.
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Rydvall A, Juth N, Sandlund M, Domellöf M, Lynøe N. To treat or not to treat a newborn child with severe brain damage? A cross-sectional study of physicians' and the general population's perceptions of intentions. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:81-88. [PMID: 23771411 DOI: 10.1007/s11019-013-9498-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50-62)] and the general population [53 % (CI 49-58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient's symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life.
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Perinatal palliative care: Parent perceptions of caring in interactions surrounding counseling for risk of delivering an extremely premature infant. Palliat Support Care 2013; 13:145-55. [PMID: 24183005 DOI: 10.1017/s1478951513000874] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE When infants are at risk of being born at a very premature gestation (22-25 weeks), parents face important life-support decisions because of the high mortality for such infants. Concurrently, providers are challenged with providing parents a supportive environment within which to make these decisions. Practice guidelines for medical care of these infants and the principles of perinatal palliative care for families can be resources for providers, but there is limited research to bridge these medical and humanistic approaches to infant and family care. The purpose of this article is to describe how parents at risk of delivering their infant prior to 26 weeks gestation interpreted the quality of their interpersonal interactions with healthcare providers. METHODS Directed content analysis was employed to perform secondary analysis of data from 54 parents (40 mothers and 14 fathers) from the previously coded theme "Quality of Interactions." These categorized data described parents' encounters, expectations, and experiences of interactions that occurred prenatally with care providers. For this analysis, Swanson's theory of caring was selected to guide analysis and to delineate parents' descriptions of caring and uncaring interactions. RESULTS Parents' expectations for caring included: (a) respecting parents and believing in their capacity to make the best decisions for their family (maintaining belief); (b) understanding parents' experiences and their continued need to protect their infant (knowing); (c) physically and emotionally engaging with the parents (being with); (d) providing unbiased information describing all possibilities (enabling); and (e) helping parents navigate the system and creating a therapeutic environment for them in which to make decisions (doing for). SIGNIFICANCE OF RESULTS Understanding parents' prenatal caring expectations through Swanson's theory gives deeper insights, aligning their expectations with the palliative care movement.
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Eventov-Friedman S, Kanevsky H, Bar-Oz B. Neonatal end-of-life care: a single-center NICU experience in Israel over a decade. Pediatrics 2013; 131:e1889-96. [PMID: 23669519 DOI: 10.1542/peds.2012-0981] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious. METHODS All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods: 2000-2004 versus 2005-2009. RESULTS Overall, 239 neonates died. The leading cause of death in both study periods was prematurity and its complications (76%). Among term infants, the leading cause of death was congenital anomalies (48%). Fifty-six percent of the infants received maximal intensive care; 28% had redirection of intensive care, of whom 10% had withdrawal of life-sustaining treatment; and 16% had primary nonintervention care. Over the years, maximal intensive care decreased from 65% to 46% (P < .02), whereas redirection of care increased from 19.2% to 37.5% (P < .0005). An active parental role in the end-of-life decision process increased from 38% to 84%. CONCLUSIONS Even among religious families of extremely sick neonates, redirection of care is a feasible treatment option, suggesting that apart from survival, quality-of-life considerations emerge as an important factor in the decision-making process for the infant, parents, and caregivers.
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Affiliation(s)
- Smadar Eventov-Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Centers, Jerusalem, Israel.
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