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Delamere T, Balfe J, Fraser LK, Sheaf G, Smith S. Defining and quantifying population-level need for children's palliative care: findings from a rapid scoping review. BMC Palliat Care 2024; 23:212. [PMID: 39174940 PMCID: PMC11340184 DOI: 10.1186/s12904-024-01539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The number of children who require palliative care has been estimated to be as high as 21 million globally. Delivering effective children's palliative care (CPC) services requires accurate population-level information on current and future CPC need, but quantifying need is hampered by challenges in defining the population in need, and by limited available data. The objective of this paper is to summarise how population-level CPC need is defined, and quantified, in the literature. METHODS Scoping review performed in line with Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR guidelines. Six online databases (CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Web of Science), and grey literature, were searched. INCLUSION CRITERIA literature published in English; 2008-2023 (Oct); including children aged 0-19 years; focused on defining and/or quantifying population-level need for palliative care. RESULTS Three thousand five hundred seventy-eight titles and abstracts initially reviewed, of which, 176 full-text studies were assessed for eligibility. Overall, 51 met the inclusion criteria for this scoping review. No universal agreement identified on how CPC need was defined in population-level policy and planning discussions. In practice, four key definitions of CPC need were found to be commonly applied in quantifying population-level need: (1) ACT/RCPCH (Association for Children with Life-Threatening or Terminal Conditions and their Families, and the Royal College of Paediatrics and Child Health) groups; (2) The 'Directory' of Life-Limiting Conditions; (3) 'List of Life-Limiting Conditions'; and (4) 'Complex Chronic Conditions'. In most cases, variations in data availability drove the methods used to quantify population-level CPC need and only a small proportion of articles incorporated measures of complexity of CPC need. CONCLUSION Overall, greater consistency in how CPC need is defined for policy and planning at a population-level is important, but with sufficient flexibility to allow for regional variations in epidemiology, demographics, and service availability. Improvements in routine data collection of a wide range of care complexity factors could facilitate estimation of population-level CPC need and ensure greater alignment with how need for CPC is defined at the individual-level in the clinical setting.
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Affiliation(s)
- Tara Delamere
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Joanne Balfe
- LauraLynn Ireland's Children's Hospice and Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Lorna K Fraser
- Cicely Saunders Institute of Palliative Care, King's College London, London, UK
| | - Greg Sheaf
- Library of Trinity College Dublin, Dublin, Ireland
| | - Samantha Smith
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
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Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
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Bluhme E, Henckel E, Jorns C. Potential of neonatal organ donation and outcome after transplantation. Pediatr Transplant 2023; 27:e14486. [PMID: 36792069 DOI: 10.1111/petr.14486] [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] [Received: 09/03/2021] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.
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Affiliation(s)
- Emil Bluhme
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carl Jorns
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
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Fernández-Fructuoso JR, Gil-Sánchez FJ, Sáez-Miravete S, Pina-Molina JM, Fuentes-Gutiérrez C, Lloreda-García JM, Olmo-Sánchez M, Mañas-Uxo MI, García-González A, Leante-Castellanos JL. Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single-center experience. Pediatr Transplant 2022; 26:e14403. [PMID: 36165676 DOI: 10.1111/petr.14403] [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] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.
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Affiliation(s)
| | | | - Salvadora Sáez-Miravete
- Intensive Care Unit, Donor Coordination Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - José Miguel Pina-Molina
- Pediatric Emergency Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | - María Olmo-Sánchez
- Neonatology Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | - Ana García-González
- Neonatology Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
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Abstract
BACKGROUND Neonatal intensive care unit (NICU) nurses require knowledge and skill to meet the unique needs of infants and families. Increasingly, principles of palliative care are being integrated into the NICU setting to improve the quality of care. PURPOSE The purpose of this article is to describe the efforts of the End-of-Life Nursing Education Consortium (ELNEC) project and its Pediatric Curriculum, which began in 2003 to provide this education, and to also describe efforts by nurses to implement the training into their practice settings. METHODS The ELNEC Pediatric Palliative Care (ELNEC-PPC) project is a train-the-trainer educational program and evidence-based curriculum. FINDINGS/RESULTS Participants attend a course or receive online training and then apply the education to implement improved practices in areas such as symptom management, care at the time of death, and bereavement support for families. IMPLICATIONS FOR RESEARCH Experiences with ELNEC-PPC have demonstrated that nurses can implement the curriculum to improve care. IMPLICATIONS FOR PRACTICE Continued attention to palliative care in this setting is needed, and future research is needed to evaluate the outcomes of this education and practice change.
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Depoers-Béal C, Le Baccon FA, Le Bouar G, Proisy M, Arnaud A, Legendre G, Dayan J, Bétrémieux P, Le Lous M. Perinatal grief following neonatal comfort care for lethal fetal condition. J Neonatal Perinatal Med 2019; 12:457-464. [PMID: 31282431 DOI: 10.3233/npm-180180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25%. CONCLUSION Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA.
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Affiliation(s)
- C Depoers-Béal
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - F A Le Baccon
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - G Le Bouar
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - M Proisy
- Department of Radiology, University Hospital of Rennes, Rennes, France
| | - A Arnaud
- Department of Pediatric Surgery, University Hospital of Rennes, Rennes, France
| | - G Legendre
- Department of Obstetrics and Gynecology, University Hospital of Angers, Angers, France
| | - J Dayan
- Department of Psychiatry, University Hospital of Rennes, Rennes, France
| | - P Bétrémieux
- Department of Pediatrics, University Hospital of Rennes, Rennes, France
| | - M Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
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LoGiudice JA, O'Shea E. Perinatal palliative care: Integration in a United States nurse midwifery education program. Midwifery 2018; 58:117-119. [PMID: 29331534 DOI: 10.1016/j.midw.2017.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 11/27/2022]
Abstract
Midwifery students with perinatal palliative care education develop a skillset to provide holistic midwifery care to women and families who are experiencing stillbirth or life-limiting fetal diagnoses. This paper presents a model of perinatal palliative care in a United States midwifery education program. By utilizing evidence based practices and national programs, perinatal palliative care can be threaded through midwifery curricula to achieve international standards of practice and competencies. Most importantly, enhancing perinatal palliative care education will better prepare future midwives for when a birth outcome is not what was expected at the outset of a pregnancy.
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Affiliation(s)
- Jenna A LoGiudice
- Fairfield University, Egan School of Nursing and Health Studies, 1073 N. Benson Road, Fairfield, CT 06824, United States.
| | - Eileen O'Shea
- Fairfield University, Egan School of Nursing and Health Studies, 1073 N. Benson Road, Fairfield, CT 06824, United States.
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