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Osteen K, Tucker CA, Meraz R. We Have to Really Decide: The Childbearing Decisions of Women With Congenital Heart Disease. J Cardiovasc Nurs 2024; 39:325-334. [PMID: 37747321 DOI: 10.1097/jcn.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. OBJECTIVE The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. METHODS Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. RESULTS Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). CONCLUSION Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs.
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van Bockxmeer JJ, Haining CM, Atkinson A. Advance care planning for pregnant patients. Med J Aust 2023; 218:161-164. [PMID: 36549666 DOI: 10.5694/mja2.51820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/18/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Casey M Haining
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD.,Centre for Health Equity, University of Melbourne, Melbourne, VIC
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Herrick N, Al-Rousan T, Rodriguez C, Lee JH, Valente AM, Stone J, Ramos G, Asante-Boateng B, El-Said H, Moceri-Casas M, Alshawabkeh L. Priorities and Understanding of Pregnancy Among Women With Congenital Heart Disease: A Mixed-Methods Study. JACC. ADVANCES 2022; 1:100112. [PMID: 38939700 PMCID: PMC11198376 DOI: 10.1016/j.jacadv.2022.100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/29/2024]
Abstract
Background Many women with congenital heart disease (CHD) desire safe and successful pregnancies, but a significant proportion does not seek prepregnancy counseling. Objectives This study aims to distinguish the personal priorities and perceptions about pregnancy in this growing population. Methods Women aged 18 to 50 years with CHD were enrolled from 2 sites. Using a mixed-methods approach (Q-methodology), 179 participants sorted 23 statements representing a collection of views on pregnancy using priority forced ranking along a scale from "strongly agree" to "strongly disagree." Results Majority of women were between 25 and 29 years of age, had moderate or severely complex CHD, and were married. Five unique group identities were elucidated from patient responses. Group 1 was centered around a strong desire to start a family. Women in group 2 had significant anxiety, and their psychological wellbeing interfered with their decision to start a family. Women in group 3 were concerned about premature death; if they do have kids, they want to be alive to see them grow old. Women in group 4 had strong objections to termination. Group 5 valued health care engagement. Group identities were unrelated to CHD complexity and demographic factors such as age and marital status. Six differentiating statements were identified that help distinguish which group a woman aligns with. Conclusions Women with CHD have diverse priorities and values relating to pregnancy and heart disease. This study used a mixed-methods approach to provide a framework identifying several domains for targeted prepregnancy counseling in women with CHD.
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Affiliation(s)
- Nicole Herrick
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity, University of California-San Diego, San Diego, California, USA
| | - Carla Rodriguez
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ji Hae Lee
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Stone
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Gladys Ramos
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Bendelyn Asante-Boateng
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Maria Moceri-Casas
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Laith Alshawabkeh
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Annemans L, Moniotte S, de Hosson M, Marelli A, Moons P. Last year of life of adults with congenital heart diseases: causes of death and patterns of care. Eur Heart J 2022; 43:4483-4492. [PMID: 36030410 PMCID: PMC9637423 DOI: 10.1093/eurheartj/ehac484] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Although life expectancy in adults with congenital heart diseases (CHD) has increased dramatically over the past five decades, still a substantial number of patients dies prematurely. To gain understanding in the trajectories of dying in adults with CHD, the last year of life warrants further investigation. Therefore, our study aimed to (i) define the causes of death and (ii) describe the patterns of healthcare utilization in the last year of life of adults with CHD. METHODS AND RESULTS This retrospective mortality follow-back study used healthcare claims and clinical data from BELCODAC, which includes patients with CHD from Belgium. Healthcare utilization comprises cardiovascular procedures, CHD physician contacts, general practitioner visits, hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, and specialist palliative care, and was identified using nomenclature codes. Of the 390 included patients, almost half of the study population (45%) died from a cardiovascular cause. In the last year of life, 87% of patients were hospitalized, 78% of patients had an ED visit, and 19% of patients had an ICU admission. Specialist palliative care was provided to 17% of patients, and to only 4% when looking at the patients with cardiovascular causes of death. CONCLUSIONS There is a high use of intensive and potentially avoidable care at the end of life. This may imply that end-of-life care provision can be improved. Future studies should further examine end-of-life care provision in the light of patient's needs and preferences, and how the healthcare system can adequately respond.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Research Foundation Flanders (FWO), 1000, Brussels, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, 2000, Antwerp, Belgium
| | - Lucas Morin
- Inserm CIC 1431, University Hospital of Besançon, 25000, Besançon, France,Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800, Villejuif, France
| | - Koen Luyckx
- Department of Psychology and Educational Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium,Unit for Professional Training and Service in the Behavioural Sciences (UNIBS), University of the Free State, 9300, Bloemfontein, South Africa
| | - Fouke Ombelet
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Division of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium,Lab of Neurology, VIB – KU Leuven Centre for Brain and Disease Research, 3000, Leuven, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Stéphane Moniotte
- Division of Pediatric and Congenital Cardiology, Department of Paediatrics, Cliniques universitaires Saint-Luc, 1000, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Arianne Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, H3A 0G4, Montréal (Quebec), Canada
| | - Philip Moons
- Corresponding author. Tel: +32 16 37 33 15, Fax: +32 16 33 69 70,
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