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Abou Mehrem A, Toye J, Beltempo M, Aziz K, Bizgu V, Wong J, Singhal N, Shah PS. Process and Outcome Measures for Infants Born Moderate and Late Preterm in Tertiary Canadian Neonatal Intensive Care Units. J Pediatr 2024; 269:113976. [PMID: 38401787 DOI: 10.1016/j.jpeds.2024.113976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To describe the prevalence of and between-center variations in care practices and clinical outcomes of moderate and late preterm infants (MLPIs) admitted to tertiary Canadian neonatal intensive care units (NICUs). STUDY DESIGN This was a retrospective cohort study including infants born at 320/7 through 366/7 weeks of gestation and admitted to 25 NICUs participating in the Canadian Neonatal Network between 2015 and 2020. Patient characteristics, process measures represented by care practices, and outcome measures represented by clinical in-hospital and discharge outcomes were reported by gestational age weeks. NICUs were compared using indirect standardization after adjustment for patient characteristics. RESULTS Among 25 669 infants (17% of MLPIs born in Canada during the study period) included, 45% received deferred cord clamping, 7% had admission hypothermia, 47% received noninvasive respiratory support, 11% received mechanical ventilation, 8% received surfactant, 40% received antibiotics in the first 3 days, 4% did not receive feeding in the first 2 days, and 77% had vascular access. Mortality, early-onset sepsis, late-onset sepsis, or necrotizing enterocolitis occurred in <1% of the study cohort. Median (IQR) length of stay was 14 (9-21) days among infants discharged home from the admission hospital and 5 (3-9) days among infants transferred to community hospitals. Among infants discharged home, 33% were discharged on exclusive breastmilk and 75% on any breastmilk. There were significant variations between NICUs in all process and outcome measures. CONCLUSIONS Care practices and outcomes of MLPIs varied significantly between Canadian NICUs. Standardization of process and outcome quality measures for this population will enable benchmarking and research, facilitating systemwide improvements.
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Affiliation(s)
- Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - Jennifer Toye
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marc Beltempo
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Khalid Aziz
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Victoria Bizgu
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jonathan Wong
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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2
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Santoro D, Zibulsky DA, Roehr CC, Langhammer F, Vento M, Szczapa T, Fauchère JC, Dimitriou G, Rabe H, Mader S, Zimmermann LJI, Murray DM, Smith S, Hall M, Künzel M, Wellmann S. Meeting the need for effective and standardized neonatology training: a pan-European Master's Curriculum. Pediatr Res 2024:10.1038/s41390-024-03182-8. [PMID: 38702380 DOI: 10.1038/s41390-024-03182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/20/2024] [Accepted: 03/10/2024] [Indexed: 05/06/2024]
Abstract
Neonatology is a pediatric sub-discipline focused on providing care for newborn infants, including healthy newborns, those born prematurely, and those who present with illnesses or malformations requiring medical care. The European Training Requirements (ETR) in Neonatology provide a framework for standardized quality and recognition of equality of training throughout Europe. The latest ETR version was approved by the Union of European Medical Specialists (UEMS) in April 2021. Here, we present the curriculum of the European School of Neonatology Master of Advanced Studies (ESN MAS), which is based on the ETR in Neonatology and aims to provide a model for effective and standardized training and education in neonatal medicine. We review the history and theory that form the foundation of contemporary medical education and training, provide a literature review on best practices for medical training, pediatric training, and neonatology training specifically, including educational frameworks and evidence-based systems of evaluation. The ESN MAS Curriculum is then evaluated in light of these best practices to define its role in meeting the need for a standardized empirically supported neonatology training curriculum for physicians, and in the future for nurses, to improve the quality of neonatal care for all infants. IMPACT STATEMENT: A review of the neonatology training literature was conducted, which concluded that there is a need for standardized neonatology training across international contexts to keep pace with growth in the field and rapidly advancing technology. This article presents the European School of Neonatology Master of Advanced Studies in Neonatology, which is intended to provide a standardized training curriculum for pediatricians and nurses seeking sub-specialization in neonatology. The curriculum is evaluated in light of best practices in medical education, neonatology training, and adult learning theory.
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Affiliation(s)
- Deanna Santoro
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | | | - Charles C Roehr
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Florian Langhammer
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Max Vento
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| | - Tomasz Szczapa
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - J-C Fauchère
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gabriel Dimitriou
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- Department of Paediatrics, University of Patras Medical School, Patras, Greece
| | - Heike Rabe
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Silke Mader
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Luc J I Zimmermann
- European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
- Department of Paediatrics-Neonatology and School for Oncology and Reproduction, Maastricht UMC+, Maastricht, The Netherlands
| | - Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Susan Smith
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Hall
- European Society for Paediatric Research (ESPR), Satigny, Switzerland
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Sven Wellmann
- European Society for Paediatric Research (ESPR), Satigny, Switzerland.
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.
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Boutillier B, Ethier G, Boucoiran I, Reichherzer M, Luu TM, Morin L, Pearce R, Janvier A. Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1570. [PMID: 37761531 PMCID: PMC10529479 DOI: 10.3390/children10091570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.
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Affiliation(s)
- Béatrice Boutillier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Guillaume Ethier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Reichherzer
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Thuy Mai Luu
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Lucie Morin
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Rebecca Pearce
- Parent Representative, Collaborates with Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada;
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
- Bureau de L’éthique Clinique (BEC), Université de Montréal, Montréal, QC H3C 3J7, Canada
- Unité de Soins Palliatifs, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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4
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Hintz SR, deRegnier RA, Vohr BR. Outcomes of Preterm Infants: Shifting Focus, Extending the View. Clin Perinatol 2023; 50:1-16. [PMID: 36868700 DOI: 10.1016/j.clp.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Advances in perinatal care have led to remarkable long-term survival for infants who are born preterm. This article reviews the broader context of follow-up care, highlighting the need to reenvision some areas, such as improving parental support by embedding parental involvement in the neonatal intensive care unit, incorporating parental perspectives about outcomes into follow-up care models and research, supporting their mental health, addressing social determinants of health and disparities, and advocating for change. Multicenter quality improvement networks allow identification and implementation of best practices for follow-up care.
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Affiliation(s)
- Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, 4th Floor, Palo Alto, CA 94304, USA.
| | - Raye-Ann deRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA
| | - Betty R Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
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5
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Shankland M, Ferrand A, Ganache I, Côté MA, Pomey MP. Ethical Foundations of the Accompanying Patient's Role for an Enhanced Patient Experience: A Scoping Review. J Pers Med 2022; 13:jpm13010077. [PMID: 36675737 PMCID: PMC9863322 DOI: 10.3390/jpm13010077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
In recent years, recognizing patients' experiential knowledge to improve the quality of care has resulted in the participation of patient advisors at various levels of healthcare systems. Some who are working at the clinical level are called accompanying patients (AP). A PRISMA-ScR exploratory scoping review of the literature was conducted on articles published from 2005 to 2021. Articles not in English or French and grey literature were excluded. The databases searched included Medline, PubMed, Scopus, and Google Scholar. The data were organized according to the similarities in the ethical foundations of the included papers. Out of 2095 identified papers, 8 met inclusion criteria. Terms used to describe APs included peer support, resource parent, and peer health mediator. The clinical settings included psychiatry/mental health and neonatology. APs, patients, healthcare professionals, managers and policy makers were included in the studies. Three personal ethical foundations describing the foundations of the AP role were found: resilience, listening skills and altruism. The ethical foundations of this role also addressed interpersonal and interprofessional relationships with other actors in the healthcare system. The literature on the ethical foundations of APs is sparse, with heterogeneous methodologies. Further studies mobilizing well-defined methodologies would further validate the current results and deepen our understanding of the ethical foundations of the AP role.
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Affiliation(s)
- Mylène Shankland
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
- Correspondence:
| | - Amaryllis Ferrand
- Pragmatic Health Ethics Research Unit, Montreal Clinical Research Institute (IRCM), Université de Montréal, Montréal, QC H2W 1R7, Canada
| | - Isabelle Ganache
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
| | | | - Marie-Pascale Pomey
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
- CHUM Research Centre, Health Innovation and Evaluation Hub, Montréal, QC H2X 0A9, Canada
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6
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Thivierge E, Luu TM, Bourque CJ, Duquette LA, Pearce R, Jaworski M, Barrington KJ, Synnes A, Janvier A. Guilt and Regret Experienced by Parents of Children Born Extremely Preterm. J Pediatr 2022:S0022-3476(22)01019-8. [PMID: 36463935 DOI: 10.1016/j.jpeds.2022.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To explore decisional regret of parents of babies born extremely preterm and analyze neonatal, pediatric, and parental factors associated with regret. STUDY DESIGN Parents of infants born <29 weeks of gestational age, aged between 18 months and 7 years, attending neonatal follow-up were enrolled. Hospital records were reviewed to examine morbidities and conversations with parents about levels of care. Parents were asked the following question: "Knowing what you know now, is there anything you would have done differently?" Mixed methods were used to analyze responses. RESULTS In total, 248 parents (98% participation) answered, and 54% reported they did not have regret. Of those who reported regret (n = 113), 3 themes were most frequently invoked: 35% experienced guilt, thinking they were responsible for the preterm birth; 28% experienced regret about self-care decisions; and 20% regretted decisions related to their parental role, generally wishing they knew sooner how to get involved. None reported regret about life-and-death decisions made at birth or in the neonatal intensive care unit. Impairment at follow-up, gestational age, and decisions about levels/reorientation of care were not associated with regret. More mothers reported feeling guilt about the preterm birth (compared with fathers); parents of children with severe lesions on ultrasonography of the head were less likely to report regret. CONCLUSIONS Approximately one-half of the parents of infants born extremely preterm had regrets regarding their neonatal intensive care unit stay. Causes of regret and guilt should be addressed and minimized.
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Affiliation(s)
- Emilie Thivierge
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada; Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montréal, Canada
| | | | - Rebecca Pearce
- Canadian Premature Baby Foundation, Montréal, Quebec, Canada
| | - Magdalena Jaworski
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada
| | - Keith J Barrington
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Anne Synnes
- Department of Pediatrics, BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Janvier
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada; Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montréal, Canada; Bureau de l'éthique Clinique, Université de Montréal, Montréal, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Canada.
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Implementation Outcomes and Challenges of Partnerships between Resource Parents and Parents with Sick Infants in Intensive Neonatal Care Units: A Scoping Review. CHILDREN 2022; 9:children9081112. [PMID: 35892615 PMCID: PMC9331213 DOI: 10.3390/children9081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Parents with a sick child in a neonatal intensive care unit (NICU) usually experience stress, anxiety, and vulnerability. These precarious feelings can affect early parent–child interactions and have consequences for the child’s neurodevelopment. Parents who have had a sick child in an NICU (veteran parents) can offer helpful interventions for these vulnerable families. This article is a scoping review of parental interventions used with the families of NICU infants, and an overview of French perspectives. Two independent reviewers studied the scientific literature published in English between 2001 to 2021 using Covidence software. The databases used were MEDLINE, ISI Web of Science, the Cochrane Database, and Google Scholar. Themes were identified from the articles’ results using an open coding approach. The data are presented in a narrative format. Ten articles were included, and four major themes addressed: (1) description of activities, (2) recommendations, (3) impact, and (4) barriers (resulting from recruitment, training, remuneration, and organization). Activities were very diverse, and a step-by-step implementation was recommended by all authors. Peer-support interventions might be a potential resource for those anxious parents and improve their NICU experiences. These challenges are described by SOS Préma in France. This article brings together recent studies on partnership in the NICU. It is an innovative topic in neonatology with vast issues to explore.
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Personalized support of parents of extremely preterm infants before, during and after birth. Semin Fetal Neonatal Med 2022; 27:101335. [PMID: 35780043 DOI: 10.1016/j.siny.2022.101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The emotional turmoil associated with extremely preterm birth is inescapable parents. How each parent handles the unexpected, makes sense of the unknown and learns to parent their child is uniquely personal. A rigid standardized approach to support families through their journey before and during neonatal intensive care disregards this individuality. This article reviews general concepts and practices that can be learned and applied by clinicians to promote resiliency and help parents cope adaptively. This review will describe how to personalize parenting support during the antenatal consultation and hospitalization for parents of extremely premature infants. To facilitate this, mindsets and care delivery models need to shift from inflexible standardized protocols to flexible guidelines that enable personalized communications, support structures and care delivery models tailored to each person's characteristics, preferences, and values.
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology. J Pediatr 2022; 243:85-90.e2. [PMID: 34843711 DOI: 10.1016/j.jpeds.2021.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Espace Éthique Méditerranéen, Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Marseille, France
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Melissa Savaria
- Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Préma-Québec, Quebec, Quebec, Canada; Bureau de l'Éthique Clinique, University of Montreal, Montreal, Quebec, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montreal, Quebec, Canada.
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10
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Janvier A, Asaad MA, Reichherzer M, Cantin C, Sureau M, Prince J, Luu TM, Barrington KJ. The ethics of family integrated care in the NICU: Improving care for families without causing harm. Semin Perinatol 2022; 46:151528. [PMID: 34863579 DOI: 10.1016/j.semperi.2021.151528] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The philosophy of care in Neonatal Intensive care Units (NICU) has changed with increasing integration of families. We examined parents' and clinicians' perspective about Family Integrated Care (FiCare) in our quaternary NICU. We found that parents and clinicians reported many benefits for families. They were all enthusiastic about FiCare for non-medical items such as changing diapers and skin-to-skin care; for more medical items, such as presenting at rounds, being present during resuscitation or procedures, most physicians wished for more parental involvement, more than other professionals, even parents. All parents described how FiCare benefited them, had empowered them, helped them feel like parents and become a family; but several parents, who could not participate as much or did not want to assume clinical roles, reported feeling guilty. Having a flexible, yet transparent FiCare philosophy is key, as opposed to having homogeneous goals. For example, an aim to have all parents present at rounds in a quality improvement initiative can cause harm to some families. We suggest how to ethically improve FiCare in the best interest of families while minimizing harms. It is important for FiCare not to be "Family Imposed Care." Optimizing FiCare can only be done when parents' priorities guide our actions, while also keeping in mind clinicians' perspectives and respecting the reality of each NICU.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada; Bureau de l'éthique clinique (BEC), Université de Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Canada; Unité de recherche en éthique clinique et partenariat famille (UREPAF), Canada; Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Montréal, Canada.
| | - Michael-Andrew Asaad
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada
| | | | - Catherine Cantin
- Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Montréal, Canada
| | - Maia Sureau
- Parent Representative (resource parent), Canada
| | | | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Keith J Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
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11
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Forth FA, Hammerle F, König J, Urschitz MS, Neuweiler P, Mildenberger E, Kidszun A. The COPE-Trial-Communicating prognosis to parents in the neonatal ICU: Optimistic vs. PEssimistic: study protocol for a randomized controlled crossover trial using two different scripted video vignettes to explore communication preferences of parents of preterm infants. Trials 2021; 22:884. [PMID: 34872601 PMCID: PMC8647439 DOI: 10.1186/s13063-021-05796-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the numerous challenges preterm birth poses for parents and physicians is prognostic disclosure. Prognoses are based on scientific evidence and medical experience. They are subject to individual assessment and will generally remain uncertain with regard to the individual. This can result in differences in prognostic framing and thus affect the recipients' perception. In neonatology, data on the effects of prognostic framing are scarce. In particular, it is unclear whether parents prefer a more optimistic or a more pessimistic prognostic framing. OBJECTIVE To explore parents' preferences concerning prognostic framing and its effects on parent-reported outcomes and experiences. To identify predictors (demographic, psychological) of parents' communication preferences. DESIGN, SETTING, PARTICIPANTS Unblinded, randomized controlled crossover trial (RCT) at the Division of Neonatology of the University Medical Center Mainz, Germany, including German-speaking parents or guardians of infants born preterm between 2010 and 2019 with a birth weight < 1500 g. Inclusion of up to 204 families is planned, with possible revision according to a blinded sample size reassessment. INTERVENTION Embedded in an online survey and in pre-specified order, participants will watch two video vignettes depicting a more optimistic vs. a more pessimistic framing in prognostic disclosure to parents of a preterm infant. Apart from prognostic framing, all other aspects of physician-parent communication are standardized in both videos. MAIN OUTCOMES AND MEASURES At baseline and after each video, participants complete a two-part online questionnaire (baseline and post-intervention). Primary outcome is the preference for either a more optimistic or a more pessimistic prognostic framing. Secondary outcomes include changes in state-anxiety (STAI-SKD), satisfaction with prognostic framing, evaluation of prognosis, future optimism and hope, preparedness for shared decision-making (each assessed using customized questions), and general impression (customized question), professionalism (adapted from GMC Patient Questionnaire) and compassion (Physician Compassion Questionnaire) of the consulting physician. DISCUSSION This RCT will explore parents' preferences concerning prognostic framing and its effects on physician-parent communication. Results may contribute to a better understanding of parental needs in prognostic disclosure and will be instrumental for a broad audience of clinicians, scientists, and ethicists. TRIAL REGISTRATION German Clinical Trials Register DRKS00024466 . Registered on April 16, 2021.
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Affiliation(s)
- Fiona A Forth
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- DFG-Research Training Group "Life Sciences - Life Writing", Institute for the History, Philosophy and Ethics of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Florian Hammerle
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Jochem König
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Strasse 69, 55131, Mainz, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Strasse 69, 55131, Mainz, Germany
| | - Philipp Neuweiler
- Journalistisches Seminar, Johannes Gutenberg-University Mainz, Alte Universitätsstrasse 17, 55116, Mainz, Germany
| | - Eva Mildenberger
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- DFG-Research Training Group "Life Sciences - Life Writing", Institute for the History, Philosophy and Ethics of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
| | - André Kidszun
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße, CH-3010, Bern, Switzerland
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12
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Dahan S, Jung C, Dassieu G, Durrmeyer X, Caeymaex L. Trust and consent: a prospective study on parents' perspective during a neonatal trial. JOURNAL OF MEDICAL ETHICS 2021; 47:678-683. [PMID: 32079742 DOI: 10.1136/medethics-2019-105597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to describe how parents and physicians experienced the informed consent interview and to investigate the aspects of the relationship that influenced parents' decision during the consent process for a randomised clinical trial in a tertiary neonatal intensive care unit (NICU). The secondary objective was to describe the perspectives of parents and physicians in the specific situation of prenatal informed consent. SETTING Single centre study in NICU of the Centre Hospitalier Intercommunal de Créteil, France, using a convenience period from February to May 2016. DESIGN Ancillary study to a randomised clinical trial: Prettineo. Records of interviews for consent. POPULATION parents and physicians. Mixed study including qualitative and quantitative interview data about participants' recall and feelings about the consent process. Interviews were reviewed using thematic discourse analysis. RESULTS Parents' recall and understanding of the study's main goal and design was good. Parents and physicians had a positive experience, and trust was one of the main reasons for parents to consent. Misunderstanding (bad comprehension) was the main reason for refusal.Before birth, three situations can compromise parents' consent: the mother already consented to participate in other studies, the absence of the father during the interview and the feeling that the baby's birth is not an imminent possibility. CONCLUSIONS Confronting parents and physicians' perspectives in research can help us reach answers to sensitive issues such as content and timing of information. Each different types of study raises different ethical dilemmas for consent that might be discussed in a more individual way.
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Affiliation(s)
- Sonia Dahan
- Neonatal intensive care unit, Centre hospitalier intercommunal de Créteil, Créteil, Ile-de-France, France
- Faculté de Médecine, Université Paris Est Créteil Val de Marne, Faculté de Médecine, Créteil, Ile-de-France, France
| | - Camille Jung
- Faculté de Médecine, Université Paris Est Créteil Val de Marne, Faculté de Médecine, Créteil, Ile-de-France, France
- Pediatrics, Centre hospitalier Intercommunal de Créteil Val-de-Marne, Creteil, Île-de-France, France
| | - Gilles Dassieu
- Neonatal intensive care unit, Centre hospitalier intercommunal de Créteil, Créteil, Ile-de-France, France
- Faculté de Médecine, Université Paris Est Créteil Val de Marne, Faculté de Médecine, Créteil, Ile-de-France, France
| | - Xavier Durrmeyer
- Neonatal intensive care unit, Centre hospitalier intercommunal de Créteil, Créteil, Ile-de-France, France
- Faculté de Médecine, Université Paris Est Créteil Val de Marne, Faculté de Médecine, Créteil, Ile-de-France, France
| | - Laurence Caeymaex
- Neonatal intensive care unit, Centre hospitalier intercommunal de Créteil, Créteil, Ile-de-France, France
- Faculté de Médecine, Université Paris Est Créteil Val de Marne, Faculté de Médecine, Créteil, Ile-de-France, France
- CEDITEC, Universite Paris-Est Creteil Val de Marne, Creteil, France
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13
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Weaver MS, Wiener L, Moon MM, Gordon B, Kelly KP, Hinds PS. Family Caregiver Partnerships in Palliative Care Research Design and Implementation. Pediatrics 2021; 148:peds.2020-049403. [PMID: 34103377 PMCID: PMC8276591 DOI: 10.1542/peds.2020-049403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Meaghann S. Weaver
- Division of Palliative Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, Nebraska,National Center for Ethics in Healthcare, Washington, District of Columbia
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Michelle M. Moon
- Parent, Division of Hospice and Palliative Medicine, Department of Internal Medicine, School of Medicine, University of Nevada, Reno, Nevada
| | - Bruce Gordon
- Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Katherine Patterson Kelly
- Department of Nursing Science, Professional Practice and Quality, Children's National Hospital and Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Hospital and Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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14
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Shao Q, Yuan J, Ma J, Ding H, Huang W. Exploring the determinants of synergetic development of social organizations participating in home-based elderly care service: An SEM method. PLoS One 2020; 15:e0244880. [PMID: 33382827 PMCID: PMC7775099 DOI: 10.1371/journal.pone.0244880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
The current aging service industry has problems in meeting the ever-increasing demand for the home-based elderly care service (HECS). Social organizations participating in HECS seems to be a promising way to address these problems but also raises new challenges, like uncoordinated cooperation among stakeholders, which could lead to low management efficiency and low service quality. However, Synergetic development can be promising to enhance the participation of social organizations and to improve social welfare. This study introduces a conceptual model to explore relationships between five determinants and synergetic development of social organizations participating in HECS. A structural equation model (SEM) based on questionnaire survey is used as a test methodology. The results indicated that stakeholder engagement plays a critical role in synergetic development in HECS, resource allocation can only be improved by institutional climate, and supervision capacity cannot facilitate information sharing. This study provides effective strategies and directions for the improvement of home-based elderly care services.
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Affiliation(s)
- Qiuhu Shao
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Jingfeng Yuan
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Junwei Ma
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Hongxing Ding
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, Jiangsu Province, P. R. China
| | - Wei Huang
- School of Civil Engineering, Sanjiang University, Nanjing, Jiangsu Province, P. R. China
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15
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Peer support groups for families in Neonatology: Why and how to get started? Acta Paediatr 2020; 109:2525-2531. [PMID: 32304582 DOI: 10.1111/apa.15312] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 12/28/2022]
Abstract
AIM To describe the development of peer-to-peer support meetings between parents of children in neonatal intensive care unit (NICU) and veteran resource parents who had a previous NICU experience. METHODS The study had two steps: a needs assessment and a feasibility pilot study. Parental perspectives were investigated using mixed methods. RESULTS One hundred and fifty-three parents were participated. NICU parents (89%) wished to meet resource parents to discuss: their parental role, normalising their experience and emotions, adapting to their new reality, control, guilt, trust and coping. Practical aspects of the meetings were tested/finalised. Resource parent moderators reported that the presence of more than one moderator per meeting was essential. A checklist of topics to discuss was developed. Having a diversity of moderators (fathers, diagnoses other than prematurity, for example) was judged important. The name of the meeting had an impact on attendance: there were less participants when the word "support" was used. The best location (central, parents' kitchen) and optimal time/duration of meetings, selection of parent moderators and compensation were also determined. CONCLUSION Peer support meetings moderated by resource parents provide a unique and useful means to support NICU parents. Future investigations will explore whether these meetings will improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte‐Justine Research Center Montréal QC Canada
- Unité d'éthique clinique CHU Sainte‐Justine Montréal QC Canada
- Division of Neonatology CHU Sainte‐Justine Montréal QC Canada
| | - Claude Julie Bourque
- CHU Sainte‐Justine Research Center Montréal QC Canada
- Unité d'éthique clinique CHU Sainte‐Justine Montréal QC Canada
- Unité de recherche en éthique clinique et partenariat famille (UREPAF) Montréal QC Canada
- Department of Pediatrics Université de Montréal Montréal QC Canada
- Bureau de l'Éthique Clinique (BEC) Université de Montréal Montréal QC Canada
| | | | | | - Ginette Mantha
- Parent Representative Montréal QC Canada
- Préma‐Québec Association for Preterm Infants Longueuil QC Canada
| | - Melissa Savaria
- Division of Neonatology CHU Sainte‐Justine Montréal QC Canada
| | - Annie Janvier
- CHU Sainte‐Justine Research Center Montréal QC Canada
- Unité d'éthique clinique CHU Sainte‐Justine Montréal QC Canada
- Division of Neonatology CHU Sainte‐Justine Montréal QC Canada
- Unité de recherche en éthique clinique et partenariat famille (UREPAF) Montréal QC Canada
- Department of Pediatrics Université de Montréal Montréal QC Canada
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16
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Abstract
BACKGROUND Engagement of parents as stakeholders in the research process can help ensure that interventions are aligned with their needs and experiences, but little is known about their preferences for research collaboration. PURPOSE The purpose of this qualitative, exploratory study was to explore former neonatal intensive care unit (NICU) parents' attitudes toward engagement as parent collaborators and identify potential barriers and facilitators to parent collaboration in research. METHODS Three focus groups and 3 interviews were conducted. Participants completed a demographic survey including information about their child's hospitalization. Parents were asked to discuss their NICU story, involvement in the parent community, experience with research, and factors influencing their decision to collaborate on a research study. RESULTS Nine parents completed the study. Participation was motivated by a desire to help other families. Recruitment suggestions included using parent organizations, social media networks, and advertising in the NICU. Facilitators to research engagement were passion about research topic, distance participation, affecting change, helping other parents, and compensation. Barriers included time constraints and unresolved trauma. IMPLICATIONS FOR PRACTICE NICU nurses can leverage their relationships with parents to act as liaisons between research teams and parents, helping recruit and encouraging them to form research partnerships. IMPLICATIONS FOR RESEARCH Parents are interested in collaborating with neonatal research teams when they can improve experiences for other families and can see or help implement change. Researchers should be conscious of constraints on parents' ability to meet frequently or in person and offer accommodations such as conference calls and online training.
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17
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Bourque CJ, Dahan S, Mantha G, Reichherzer M, Janvier A. My child's legacy: a mixed methods study of bereaved parents and providers' opinions about collaboration with NICU teams in quality improvement initiatives. BMJ Open 2020; 10:e034817. [PMID: 32895262 PMCID: PMC7476470 DOI: 10.1136/bmjopen-2019-034817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although stakeholders' participation in healthcare is increasingly recommended, bereaved parents are often excluded for perceived potential risks to them. The objective of this study is to describe the ongoing involvement and the perspectives of bereaved parents engaged in different types of activities in Neonatal Intensive Care Units and providers who work with them. DESIGN/METHODS Mixed methods convergent analysis. SETTING Canadian paediatric tertiary care university hospital. PARTICIPANTS All bereaved members of the resource parents group (n=8) and most providers who work with them (n=16) answered a satisfaction/needs questionnaires. RESULTS Since 2011, eight bereaved parents were involved in a large number of activities mostly related to palliative care (research, education or clinical care initiatives). Three engaged in peer-to-peer support activities while the others preferred activities outside of clinical units and/or without direct interactions with other families. All of them reported that their participation had positive impacts, but two parents also reported a reactivation of traumatic experiences during a medical simulation activity. All participants expressed a desire for further collaboration. Motivation to contribute gravitated around two central themes: helping others and helping themselves. Many wanted to give back, help other families, improve the system and meet with providers who had cared for their child. All stated that this kind of involvement empowered them and gave meaning to their experiences. Providers and researchers all reported positive experiences, mainly due to the unique perspectives of bereaved parents who took part in their projects. CONCLUSIONS With careful recruitment and supervision, some bereaved parents can become resource parents involved in different types of activities. It is important to understand the positive impacts this type of engagement can have on their healing process and to control the risks related to their participation. Research is needed to develop pertinent tools and measures to evaluate the outcomes and impacts of their participation.
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Affiliation(s)
- Claude Julie Bourque
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, Canada
- Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Sonia Dahan
- Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- Division of Neonatology, CHU Sainte-Justine, Montréal, Quebec, Canada
| | | | | | - Annie Janvier
- CHU Sainte-Justine Research Center, CHU Sainte-Justine, Montréal, Quebec, Canada
- Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- Division of Neonatology, CHU Sainte-Justine, Montréal, Quebec, Canada
- Québec Research Network on Palliative and End-of-Life Care, RQSPAL, Montréal, Québec, Canada
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18
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Bourque CJ, Bonanno M, Dumont É, Gaucher N, Lacoste-Julien A, Gomez-Tyo M, Langlet MF, Sultan S. The Integration of Resource Patients in Collaborative Research: A Mixed Method Assessment of the Nesting Dolls Design. PATIENT EDUCATION AND COUNSELING 2020; 103:1830-1838. [PMID: 32418681 DOI: 10.1016/j.pec.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This is a quality assessment of a research design developed for a collaborative study on adolescents and young adults who survived a brain tumor. METHODS A descriptive and critical mixed methods approach was used to assess the design itself, the quality and information power of the database and the integration of collaborators. Project documentation, field notes and transcripts from focus groups interviews(n = 19) were used for the evaluation, which was based on the Consolidated Criteria for Reporting Qualitative Research. RESULTS The design proved to be pertinent to resolve methodological stakes in a "fragile field". The mobilisation of collaborators as members of a "Sherpa team" in all phases of the project helped the team create a progressive focus approach well-adapted for data gathering and analysis as well as produce a high-quality database. CONCLUSION The Nesting Dolls Design including the didactic approach developed along the deployment of the project helped researchers, clinicians and resource patients/parents understand the research procedures and the roles of all collaborators. This fostered a meaningful engagement in the project. PRACTICE IMPLICATIONS Resources and time for training, communication and supervision are necessary to reach the objectives of collaborative research involving novices and are worth the time and efforts.
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Affiliation(s)
- Claude Julie Bourque
- Sainte-Justine University Hospital (CHUSJ) Research Center, Department of Pediatrics, University of Montréal, Montréal, Canada.
| | - Marco Bonanno
- Division of Hematology-Oncology, Sainte-Justine University Hospital, Montréal, Canada
| | - Émilie Dumont
- Department of Psychology, University of Montréal, Montréal, Canada
| | - Nathalie Gaucher
- Department of Pediatrics, University of Montréal, Division of Emergency Medicine, Sainte-Justine University Hospital, Montréal, Canada
| | | | - Mathias Gomez-Tyo
- Leucan (Québec association for parents of children with cancer), Montréal, Canada
| | - Marie-France Langlet
- Patients-Families-Providers Partnership Office, Sainte-Justine University Hospital, Montréal, Canada
| | - Serge Sultan
- Psycho-Oncology Center, Sainte-Justine University Hospital, Montréal, Canada
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20
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Abstract
Parenting in the NICU is an intense journey. Parents struggle to build intimacy with their child amid complex emotions and medical uncertainties. They need to rapidly adapt their vision of parenthood to the realities of intensive care. The psychological impact of this journey can have important effects on their psychological health. For parents of sick older children, "good parent" beliefs have been shown to foster positive growth. This concept is also essential for parents of infants in the NICU, although their path is complex.We write as clinicians who were also families in the NICU. We suggest parents need to hear and internalize 3 important messages that overlap but are each important: you are a parent, you are not a bad parent, and you are a good parent. We offer practical suggestions to NICU clinicians that we believe will help NICU parents cope while their infant is in the NICU and afterward.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Montefiore Medical Center, Bronx, New York
| | - John Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montreal, Canada; and .,Clinical Ethics Unit, Palliative Care Unit, and Unité de Recherche en Èthique Clinique et Partenariat Famille, Division of Neonatology, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
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21
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Lizotte MH, Barrington KJ, Sultan S, Pennaforte T, Moussa A, Lachance C, Sureau M, Zao Y, Janvier A. Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology. Pediatrics 2020; 145:peds.2019-1925. [PMID: 31988171 DOI: 10.1542/peds.2019-1925] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. METHODS Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. RESULTS Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations >9 out of 10 and were all ranked top 10 communicators. CONCLUSIONS During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication.
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Affiliation(s)
- Marie-Hélène Lizotte
- Centre de Recherche.,Department of Pediatrics, Hôpital de Rimouski, Rimouski, Canada
| | | | - Serge Sultan
- Centre de Recherche.,Departments of Pediatrics.,Psychology, and
| | - Thomas Pennaforte
- Centre de Recherche.,Education, Université de Montréal, Montréal, Canada; and
| | - Ahmed Moussa
- Centre de Recherche.,Mother-Child Simulation Center.,Division of Neonatology.,Soins Palliatifs, and.,Centre de Pédagogie Appliquée aux Sciences de la Santé, and.,Departments of Pediatrics
| | | | | | | | - Annie Janvier
- Centre de Recherche, .,Division of Neonatology.,Unités des Éthique Clinique and.,Soins Palliatifs, and.,Bureau du Partenariat Patients-Familles-Soignants, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Bureau de L'éthique Clinique.,Departments of Pediatrics
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22
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Tsang VWL, Chew SY, Junker AK. Facilitators and barriers to the training and maintenance of young persons' advisory groups (YPAGs). Int J Pediatr Adolesc Med 2019; 7:166-173. [PMID: 33319014 PMCID: PMC7729230 DOI: 10.1016/j.ijpam.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
Introduction Increasing demands from public and private healthcare coupled with national initiatives in patient-oriented research has led to an increase in avenues to allow patients to be directly involved in research. In particular, the push towards participation of children and youth has resulted in the formation of pediatric patient advisory groups with broad partnerships and consultation requests across the globe. However, there is a lack of evidence to examine the challenges in formation and training of young persons’ advisory groups (YPAGs) and management processes required thereafter. Purpose and objectives This study’s purpose is to document YPAG formation and training protocols around the world, highlight common strengths, and evaluate pitfalls and challenges. The results from this study will subsequently inform the development of standardized training protocols for children and youth to be piloted globally. Methods In this study, 17 select YPAG team leaders from 7 countries were surveyed to determine current training techniques used within existing groups. 17 youth representatives and 16 team leaders were then interviewed to gather further qualitative data on facilitators and barriers that aid or prevent successful initiation and maintenance of these groups. Qualitative interview data was coded and analyzed using NVivo by two independent reviewers (SYC, VWLT). Any inconsistencies in thematic analysis was confirmed by a third reviewer (JB). Results The most common training topics include consent and assent (64.71%), clinical trials (64.71%), and patient safety (70.59%). There are significant discrepancies to the amount of training received by each team. Most YPAGs out of the 17 groups receive no formal training (58.82%) while training sessions in the remaining 7 groups vary in both duration and frequency. Collectively, meetings ranged from 15 minutes to 6 hours long, with the majority of team meetings being 2–3 hours long (58.82%). The most common training facilitators are a positive relationship with a local hospital (82.35%) and access to a dedicated team coordinator (64.71%). 70.59% of team leaders identified a lack of access to appropriate educational materials available as a drawback to the impact of their YPAG, making this the greatest common barrier. Conclusion Bringing children and youth to the forefront of paediatric trials and clinical research facilitates appropriate patient representation in subsequent research decision-making. There is an urgency to create and implement standardized protocols for the training of children and youth, especially in preparation for national and international research consultations. This low barrier framework may be of special interest to lower-middle-income countries who wish to encourage community participation in healthcare.
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Affiliation(s)
- V W L Tsang
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - S Y Chew
- BC Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada
| | - A K Junker
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.,BC Children's Hospital, 4480 Oak St, Vancouver, BC V6H 3N1, Canada
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