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Schafer R, LoGiudice JA, Hargwood P, Wilpers A. The Role of Midwives in US Perinatal Palliative Care: A Scoping Review. J Midwifery Womens Health 2024. [PMID: 38979840 DOI: 10.1111/jmwh.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Perinatal palliative care (PPC) is a rapidly growing and essential reproductive health care option for pregnant persons with a diagnosed life-limiting fetal condition who continue their pregnancy. The provision of PPC is within the scope of basic midwifery competencies, and midwives are well-positioned to make unique and valuable contributions to interprofessional PPC teams. However, little is known about midwives' past or current involvement in PPC in the United States. METHODS This scoping review of the literature investigated what is known about the role of midwives in PPC in the United States. Multiple databases of published literature were used for this review: PubMed, CINAHL, Embase, Web of Science, ProQuest, Google Scholar, and relevant citations from identified studies. All types of English language publications addressing midwives' involvement in PPC in the United States were included, without any limitations on publication date. RESULTS The role and contributions of midwives in PPC is not well represented in existing literature. Of the 259 results identified, 7 publications met criteria for inclusion. These included 5 case reports, one quantitative research article, and one conference abstract. Midwives are involved in PPC through the provision of direct clinical care (including antepartum, intrapartum, postpartum, neonatal, bereavement, postmortem, and follow-up care) and care planning and coordination as part of an interprofessional team. DISCUSSION Despite midwives being uniquely positioned to provide holistic, family-centered, and person-centered care in situations of pregnancy with life-limiting fetal conditions, there is limited literature about their involvement in PPC in the United States. PPC should be incorporated into midwifery education and training programs. Midwives should play a central role in shaping future research and policies to ensure the accessibility and quality of PPC.
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Affiliation(s)
- Robyn Schafer
- Division of Advanced Practice, Rutgers University School of Nursing, Newark, New Jersey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jenna A LoGiudice
- Fairfield University Egan School of Nursing and Health Studies, Fairfield, Connecticut
| | - Pamela Hargwood
- Rutgers University Robert Wood Johnson Library of the Health Sciences, New Brunswick, New Jersey
| | - Abigail Wilpers
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [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: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
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Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
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Shaw KL, Spry J, Cummins C, Ewer AK, Kilby MD, Mancini A. Advance care planning in perinatal settings: national survey of implementation using Normalisation Process Theory. Arch Dis Child Fetal Neonatal Ed 2024; 109:135-142. [PMID: 37709497 DOI: 10.1136/archdischild-2023-325649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Perinatal advance care planning (PnACP) is a process of formal decision-making to help families plan for their baby's care when recognised that they may have a life-limiting condition. While PnACP is recommended in policy, there is a lack of evidence to support implementation and development in the perinatal setting. OBJECTIVE To conduct an online survey of UK and Ireland perinatal providers to examine how PnACP is operationalised in current practice. METHODS A secure online questionnaire was developed to collect data on (1) 'what' is being implemented, (2) the 'processes' being used, (3) perceived impact and (4) unmet support needs. Data were analysed using basic descriptive statistics, thematic analysis and through a conceptual lens of Normalisation Process Theory. RESULTS Questionnaires were completed by 108 health professionals working in 108 maternity and neonatal services, representing 90 organisations across the UK and Ireland. This revealed many resources and examples of good practice to support PnACP. However, there was wide variation in how PnACP was conceptualised and implemented. Existing frameworks, pathways and planning tools are not routinely embedded into care, and respondents identified many barriers that negatively impact the quality of care. They called for better integration of palliative care principles into acute settings and more investment in staff training to support families at existentially difficult times. CONCLUSIONS Priorities for additional perinatal service development include greater sharing of best practice and effective strategies to target the unique challenges of PnACP, such as time-sensitive collaborative working and decision-making in the face of high uncertainty.
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Affiliation(s)
- Karen L Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - J Spry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew K Ewer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Mark D Kilby
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- The Medical Genomics Research Group, Illumina, Cambridge, UK
| | - Alexandra Mancini
- Corporate Nursing, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- True Colours Trust, London, UK
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Beyazit U, Şirin H, Uzun ME, Kuru A, Yurdakul Y, Bütün Ayhan A, Yilmaz S. Attitudes of parents of children with ADHD towards genetic testing: Data from a Turkish sample. J Genet Couns 2023. [PMID: 38126130 DOI: 10.1002/jgc4.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
This study aimed to examine the opinions of parents with children diagnosed with attention deficit/hyperactivity disorder about genetic tests. A total of 540 parents living in Turkey participated in the study face-to-face and online. A questionnaire form prepared by the researchers was used as the data collection instrument. Face-to-face data were collected in different institutions in the cities of İzmir, Bursa and Antalya, while online data were collected through Google Forms. The results revealed that parents' views on genetic testing differed according to the sex and age of the child, as well as the parents' level of education and income, and whether the parents had genetic testing during pregnancy (p < 0.05). In the analysis, it was determined that parents' knowledge and awareness levels about genetic tests were generally low, while parents who reported that they would consider having genetic tests had concerns about the storage of their DNA materials, family conflicts that could be caused by genetic tests, and the compatibility of genetic tests with their religious beliefs.
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Affiliation(s)
- Utku Beyazit
- Child Development Department, Kumluca Health Sciences Faculty, Akdeniz University, Antalya, Turkey
| | - Hande Şirin
- Child Psychiatry Department, Bursa Higher Specialization Hospital of Education and Research, University of Health Sciences, Bursa, Turkey
| | - Mehmet Erdem Uzun
- Child Psychiatry Department, Bursa Higher Specialization Hospital of Education and Research, University of Health Sciences, Bursa, Turkey
| | - Alev Kuru
- Molecular Neuroscience, Institute of Health Sciences, University of Üsküdar, İstanbul, Turkey
| | - Yeşim Yurdakul
- Child Development Department, Kumluca Health Sciences Faculty, Akdeniz University, Antalya, Turkey
| | - Aynur Bütün Ayhan
- Child Development Department, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Serkan Yilmaz
- Faculty of Nursery, Ankara University, Ankara, Turkey
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Silveira AO, Wernet M, Franco LF, Dias PLM, Charepe Z. Parents' hope in perinatal and neonatal palliative care: a scoping review. BMC Palliat Care 2023; 22:202. [PMID: 38110974 PMCID: PMC10726497 DOI: 10.1186/s12904-023-01324-z] [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: 08/11/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The diagnosis of a life-limiting condition of a child in the perinatal or neonatal period is a threat to parental hopes. Hope is an interactional and multidimensional construct, and in palliative care, it is a determinant of quality of life, survival, acceptance and peaceful death. OBJECTIVE To map scientific evidence on parents' hope in perinatal and neonatal palliative care contexts. METHOD a scoping review theoretically grounded on Dufault and Martocchio's Framework, following the Joanna Briggs Institute methodological recommendations. Searches were performed until May 2023 in the MEDLINE, CINAHL and PsycINFO databases. The searches returned 1341 studies. RESULTS Eligible papers included 27 studies, most of which were carried out in the United States under a phenomenological or literature review approach. The centrality of women's perspectives in the context of pregnancy and perinatal palliative care was identified. The parental hope experience is articulated in dealing with the uncertainty of information and diagnosis, an approach to which interaction with health professionals is a determinant and potentially distressful element. Hope was identified as one of the determinants of coping and, consequently, linked to autonomy and parenthood. Cognitive and affiliative dimensions were the hope dimensions that predominated in the results, which corresponded to the parents' ability to formulate realistic goals and meaningful interpersonal relationships, respectively. CONCLUSION Hope is a force capable of guiding parents along the path of uncertainties experienced through the diagnosis of a condition that compromises their child's life. Health professionals can manage the family's hope by establishing sensitive therapeutic relationships that focus on the dimension of hope. The need for advanced research and intervention in parental and family hope are some of the points made in this study. PROTOCOL REGISTRATION https://osf.io/u9xr5/ .
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Affiliation(s)
- Aline Oliveira Silveira
- Faculty of Health Sciences, Graduate Program in Nursing, University of Brasília (UnB), Brasilia, Federal District, Brazil.
| | - Monika Wernet
- Biological and Health Sciences Center, Graduate Program in Nursing, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Larissa Fernandes Franco
- MSc in Health Sciences by the Graduate Program in Nursing, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Patrícia Luciana Moreira Dias
- Postdotoral researcher at the Graduate Program in Nursing, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Zaida Charepe
- Faculty of Health Sciences and Nursing Center for Interdisciplinary Research in Health (CIIS), at Universidade Católica Portuguesa, Lisbon, Portugal
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Shakes P, Cashin A, Hurley J. Threat and adaptation: The maternal lived experience of continuing pregnancy after receiving a prenatal diagnosis of agenesis of the corpus callosum. Soc Sci Med 2023; 339:116391. [PMID: 37956619 DOI: 10.1016/j.socscimed.2023.116391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
One stated objective of prenatal screening and diagnosis is the preparation for delivering a baby with medical needs or disability, however, psychosocial outcomes of parents who received a prenatal diagnosis suggest that this objective is not yet realised. Preparation may be complicated by diagnostic and prognostic uncertainty. A prenatal diagnosis that includes significant uncertainty due to the heterogeneous presentations, classifications, causes and outcomes is agenesis of the corpus callosum. As a neuroanatomical anomaly identified in the second or third trimesters, the diagnosis is likely to cause distress for expectant mothers, yet there is limited guidance for holistic support. To begin to address the paucity of research, this hermeneutic phenomenological study sought to explore, and provide a telling of the maternal experience of continuing pregnancy after a prenatal diagnosis of agenesis of the corpus callosum. Through interviews and a series of online, asynchronous and facilitated focus groups, lived experiences during pregnancy from the time of diagnosis to birth were explored with 26 mothers who participated in this international study. Themes were constructed through reflexive thematic analysis to describe the experience of the lived phenomenon. The first theme, Under Threat, included subthemes of The Threat to the Life of the Baby and Threatened Image of the Expected Family. The second theme, Day to Day Toward Adaptation, included subthemes of Holding it Together and Falling Apart, and More Than Information, Searching for Meaning, Hope and Control. To realise the commonly stated objective of prenatal diagnosis, to support maternal preparation, healthcare professionals require awareness of the profound, yet individual experience of prenatal diagnosis to adequately respond and support mothers through their continued pregnancies. Healthcare services should be designed to flexibly respond in a woman- and family-centred manner to reduce the threat and support maternal adaptation after a prenatal diagnosis.
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Affiliation(s)
- Pieta Shakes
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - Andrew Cashin
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - John Hurley
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW, 2450, Australia.
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Theroux R, Violette C. Fetal Anomaly: Family Experiences and Preferences for Care: An Integrative Review. J Perinat Neonatal Nurs 2023; 37:310-324. [PMID: 37878516 DOI: 10.1097/jpn.0000000000000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The prenatal diagnosis of a fetal anomaly is unexpected, creating a family crisis. Expectant parents are at an increased risk for perinatal depression and traumatic stress. Prior reviews examined parents' experiences when terminating but not continuing the pregnancy. This review synthesized qualitative research to describe the experiences, emotional responses, and needs of families continuing their pregnancy. METHODS An integrative review was performed using the Whitemore and Knafl methodology and PRISMA guidelines. A systematic review of peer-reviewed articles published between 2000 and 2200 on the experiences of fetal anomaly was performed using 5 databases. Eligible articles included qualitative studies describing families' experiences with a fetal anomaly diagnosis who elected to continue their pregnancy. Methodological quality was evaluated using the Critical Skills Appraisal Program checklist. RESULTS Of the 678 article results, 16 met inclusion criteria. There were 298 participants from 5 countries. The major overarching theme of Response to the Diagnosis of Fetal Anomaly was identified. The major categories were emotional response, coping strategies, influences, health care experiences, and family needs. Uncertainty and grief were the most common emotions. DISCUSSION Parents choosing to continue pregnancy benefit from compassionate, sensitive care, and accurate, concise information, provided in tailored instruction using multiple styles.
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Affiliation(s)
- Rosemary Theroux
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester (Dr Theroux); and UMASS Chan Medical School Obstetrics and Gynecology & Tan Chingfen Graduate School of Nursing, Worcester (Dr Violette)
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Tatterton MJ, Fisher MJ. 'You have a little human being kicking inside you and an unbearable pain of knowing there will be a void at the end': A meta-ethnography exploring the experience of parents whose baby is diagnosed antenatally with a life limiting or life-threatening condition. Palliat Med 2023; 37:1289-1302. [PMID: 37129319 PMCID: PMC10548777 DOI: 10.1177/02692163231172244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Parents of babies diagnosed with life limiting conditions in the perinatal period face numerous challenges. Considerations include the remainder of the pregnancy, delivery of the baby and decisions around care in the neonatal period. AIM To increase understanding of how parents experience the diagnosis of a life-limiting or life-threatening condition, during pregnancy and following the birth of their baby, by answering the question: 'what is known about the perinatal experiences of parents of babies with a life-limiting or life-threatening diagnosis?' DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative evidence. DATA SOURCES British Nursing Database, CINAHL, Medline, PsycINFO and Embase databases were searched in January 2023. FINDINGS Relationships between parents and their families and friends, and with professionals influence the needs and experiences of parents, which oscillate between positive and negative experiences, throughout parents' perinatal palliative care journey. Parents highlighted the need for control and a sense of normality relating to their parenting experience. Validation was central to the experience of parents at all stages of parenthood. Relationships between the parent and the baby were unwavering, underpinned with unconditional love. CONCLUSION Professionals, family members and friendship groups influence the experience, validating parents and their baby's identity and supporting parents in having a sense of control and normality by demonstrating empathy, and providing time and clear communication.
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Affiliation(s)
- Michael J Tatterton
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
- Bluebell Wood Children’s Hospice, North Anston, Sheffield, UK
- International Children’s Palliative Care Network, c/o Together for Short Lives, Bristol, UK
| | - Megan J Fisher
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
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Tewani K, Singh R, Wendy CPY, Jia Huan H, Jayagobi P, Teo I. Understanding the experiences of mothers receiving perinatal palliative care: A qualitative study. Palliat Med 2023; 37:1379-1388. [PMID: 37132995 DOI: 10.1177/02692163231171182] [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] [Indexed: 05/04/2023]
Abstract
BACKGROUND Despite the diagnosis of life-limiting foetal conditions, some mothers choose to continue their pregnancies. The experiences of these individuals are relatively unknown, making it difficult for perinatal palliative services to be targeted towards their needs. AIM To examine maternal experiences in perinatal palliative care among those who choose to continue their pregnancies despite life-limiting foetal condition. DESIGN Qualitative, retrospective study involving semi-structured interviews. Braun & Clarke's reflexive thematic analyses using a constructionist-interpretive approach were conducted. SETTING/PARTICIPANTS A total of 15 adult women participants who decided to continue their pregnancies after learning of life-limiting foetal diagnoses were recruited from a Singaporean tertiary hospital. Interviews were conducted in-person or via video conferencing. RESULTS Seven themes were synthesized from the data: (1) Internal upheaval - 'World turns upside down'; (2) Role of religion and spirituality in hope of miracles; (3) Support from family and close friends; (4) Navigating a fragmented healthcare system; (5) Value added by the perinatal palliative service; (6) Goodbye and grieving and (7) No regrets and other personal reflections. CONCLUSIONS Continuing a pregnancy despite the diagnosis of a life-limiting foetal condition can be challenging for mothers. To better meet their needs during this difficult period, perinatal palliative care must be patient-centred, multidisciplinary and non-judgmental. Efforts must be made to streamline the healthcare delivery process.
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Affiliation(s)
- Komal Tewani
- Perinatal Palliative Care, Women's Palliative Care Service, Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ratna Singh
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
| | - Cheong Pei Yi Wendy
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
| | | | - Pooja Jayagobi
- Duke-NUS Medical School, Singapore, Singapore
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Irene Teo
- Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School Singapore, Singapore
- Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Côté-Arsenault D. The case for perinatal palliative care and expanded research. Palliat Med 2023; 37:1286-1288. [PMID: 37787505 DOI: 10.1177/02692163231203852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Denise Côté-Arsenault
- Patricia and James R. Hemak Professor of Maternal Child Nursing, Research Institute Fellow, Trudy Busch Valentine School of Nursing, Saint Louis University, Saint Louis, MO, USA
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Tataj‐Puzyna U, Baranowska B, Szlendak B, Szabat M, Węgrzynowska M. Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis. Nurs Open 2023; 10:6817-6826. [PMID: 37391910 PMCID: PMC10495705 DOI: 10.1002/nop2.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
AIM The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. DESIGN A qualitative study. METHODS We employed the phenomenological approach and the Colaizzi strategy to analyse semi-structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. RESULTS We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; 'Searching for communitas' concerned the participation in special AC selected for the opportunity of sharing experiences; 'Searching for an individual way' concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences.
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Affiliation(s)
| | - Barbara Baranowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
| | | | | | - Maria Węgrzynowska
- Department of MidwiferyCentre of Postgraduate Medical EducationWarsawPoland
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12
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Abstract
OBJECTIVES Many serious or life-threatening neurologic conditions are first diagnosed during the fetal period, often following a routine ultrasound or sonographic evaluation after an abnormal aneuploidy screen. Such conditions represent a worrisome or unexpected finding for expectant parents, making the perinatal period a critical time point to engage and empower families encountering complex neurologic clinical scenarios. This review covers the role of perinatal palliative care in these settings. STUDY DESIGN This study is a topical review RESULTS: The prenatal identification of structural abnormalities of the brain or spinal cord, radiographic signs of hemorrhage or ischemic injury, or evidence of genetic or metabolic conditions should prompt involvement of a fetal palliative care team. The inherent prognostic uncertainty is challenging for prenatally diagnosed neurologic conditions which have difficult to predict short and long-term outcomes. While many of these conditions lead to the birth of an infant with neurodevelopmental challenges, few result in in utero demise. Palliative care beginning in the perinatal period provides an additional layer of support for families navigating complex decision-making during their pregnancy and provides continuity of care into the newborn period. Palliative care principles can help guide discussions around genetic and other diagnostic testing, fetal surgery, and birth planning. A multidisciplinary team can help support families with decision-making and through bereavement care in the setting of fetal or neonatal death. CONCLUSION Early palliative care team involvement can provide a more holistic approach to counseling, facilitate planning, and ensure that a family's goals and wishes are acknowledged throughout an infant's care trajectory. KEY POINTS · Many serious or life-threatening neurologic conditions are diagnosed during the fetal period.. · Palliative care principles should be incorporated in the fetal period for affected patients.. · Palliative care clinicians can aid parents and clinicians in shared decision-making.. · Palliative care principles should be employed by all care providers in relevant cases..
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Affiliation(s)
- Sharla Rent
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Monica E. Lemmon
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Margarita Bidegain
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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13
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Cortezzo DE, Vawter-Lee M, Shoaib A, Venkatesan C. Role of palliative care in fetal neurological consultations: Guiding through uncertainty and hope. Front Pediatr 2023; 11:1205543. [PMID: 37334218 PMCID: PMC10272582 DOI: 10.3389/fped.2023.1205543] [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: 04/14/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Fetal neurology is a rapidly evolving and expanding field. Discussions about diagnosis, prognosis, treatment options, and goals of care often begin in the antenatal period. However, there are inherent challenges to fetal counseling of neurological diagnoses due to limitations of fetal imaging, prognostic uncertainty, and variability in neurodevelopmental outcomes. In the midst of uncertainty, families are challenged with preparing a care plan for their baby while simultaneously experiencing profound grief. The paradigms of perinatal palliative care can assist with the grieving process and help frame diagnostic testing and complex decision-making within the context of a family's spiritual, cultural, and social belief system. This ultimately leads to a shared decision-making process and value driven medical care. While perinatal palliative care programs have expanded, many families faced with such diagnoses never meet with a palliative care team prior to delivery. Moreover, there is significant variability in the availability of palliative care services throughout the country. Using an illustrative vignette of a patient with a prenatally diagnosed encephalocele, this review aims to provide a basic framework of perinatal palliative care for fetal neurology diagnoses that emphasizes 1) importance of clear, consistent, and transparent communication among all subspecialists and families, 2) creation of a palliative care birth plan, 3) importance of consistent care providers and longitudinal points of contact prenatally and post-delivery, 4) close communication between the prenatal and post-natal providers to allow for optimal continuity of care, and 5) recognize that information, care plans, and goals of care often evolve over time.
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Affiliation(s)
- DonnaMaria E. Cortezzo
- Cincinnati Children's Hospital Medical Center, Division of Neonatal and Pulmonary Biology, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center, Division of Pain and Palliative Medicine, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marissa Vawter-Lee
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center, Division of Neurology, Cincinnati, OH, United States
| | - Abdullah Shoaib
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center, Division of Neurology, Cincinnati, OH, United States
| | - Charu Venkatesan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center, Division of Neurology, Cincinnati, OH, United States
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14
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Buchholtz S, Fangmann L, Siedentopf N, Bührer C, Garten L. Perinatal Palliative Care: Additional Costs of an Interprofessional Service and Outcome of Pregnancies in a Cohort of 115 Referrals. J Palliat Med 2023; 26:393-401. [PMID: 36251802 DOI: 10.1089/jpm.2022.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: An increasing number of life-limiting conditions (LLCs) is diagnosed prenatally, presenting providers with the ability to present perinatal palliative care (PnPC) services as an option. Objective: To (1) determine the profile characteristics of patients referred for prenatal palliative care counseling to Charité Universitätsmedizin Berlin, Germany; (2) evaluate pregnancy outcome; and (3) analyze the additional human resources per family required to provide specialized PnPC. Methods: Retrospective chart review of pregnant women and infants with potentially LLCs referred for prenatal palliative care counseling between 2016 and 2020. Results: A total of 115 women were referred for prenatal palliative care counseling. Most cases (57.6%) comprised trisomy 13 or 18 (n = 36) and complex congenital conditions (n = 32). Other life-limiting diagnoses included renal agenesis/severe dysplasia (n = 19), congenital heart diseases (n = 18), neurological anomalies (n = 8), and others (n = 5). In 72.0% of cases (n = 85) parents decided to continue pregnancy and plan for palliative birth. Fifty deliveries resulted in a liveborn infant: 33 of these died in the delivery room, 9 neonates died after admission to rooming-in on one of our neonatal wards, and 8 were discharged home or to a hospice. Total human resources (median, range) provided were 563 (0-2940) minutes for psychosocial and 300 (0-720) minutes for medical specialized PnPC per referral. Conclusions: Our data confirm previously observed characteristics of diagnoses, referrals, and outcomes. The provision of specialized and interprofessional PnPC services accounted for ∼14 hours per case of additional human resources.
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Affiliation(s)
- Stefan Buchholtz
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Fangmann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Siedentopf
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Rent S, Bidegain M, Lemmon ME. Neonatal neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:185-199. [PMID: 36599508 PMCID: PMC10615113 DOI: 10.1016/b978-0-12-824535-4.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal neuropalliative care is directed toward patients and families impacted by serious, life limiting, or debilitating neurologic illness in the antenatal and newborn period. This chapter will outline key considerations for clinicians hoping to provide a neuropalliative care approach antenatally, at birth, and in the neonatal intensive care unit. We focus on three core domains: (1) family-centered communication and care, (2) prognostication and decision-making, and (3) pain and symptom management. In each domain, we outline key considerations in the antenatal period, at birth, and in the neonatal intensive care unit. We also address special considerations in care at the end of life and in varied cultural and practice contexts. We conclude with suggestions for future research and key considerations for neonatal clinicians who wish to incorporate a neuropalliative approach to care into their practice.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
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16
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Hopes expressed in birth plans by women diagnosed with fetal anomalies: a qualitative study in Japan. BMC Pregnancy Childbirth 2022; 22:788. [PMID: 36274153 PMCID: PMC9588248 DOI: 10.1186/s12884-022-05115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Recent advances in prenatal screening and diagnosis have resulted in an increasing number of women receiving a diagnosis of fetal anomalies. In this study, we aimed to clarify the hopes for childbirth and parenting of women diagnosed with fetal anomalies and to suggest a family-centered care tailored for this situation in perinatal settings. Methods A descriptive qualitative study was performed. We recruited women diagnosed with fetal anomalies who were over 22 years old, beyond 22 weeks of gestation, and had scheduled pregnancy and delivery management at a tertiary perinatal medical center specializing in neonatal and pediatric care in a metropolitan area of Japan from April 2019 to December 2019. Women who were willing to participate received support from a midwife to create birth plans. Data were collected from the documented birth plans submitted by 24 women and analyzed using content analysis. Results We identified three themes of women’s hopes based on the descriptions of the submitted birth plans: (1) Hopes as women who are expecting childbirth, (2) Hopes as mothers of a baby, (3) Hopes of being involved in the family needs. Several distinctive hopes were clarified in the context of the women’s challenging situations. In describing their hopes, the women were neither overoptimistic or overstated their actual situations, nor caused embarrassment to the healthcare providers. The importance of supporting their involvement in baby matters in the way each family wants also emerged. However, several barriers to fulfilling the women’s hopes were identified including the babies’ conditions and hospital regulations against family visits or presence. Conclusion All three themes identified in the study provide important insights for analyzing more deeply ways of implementing a family-centered care for women diagnosed with fetal anomalies in perinatal settings. To improve women’s engagement in decision-making as a team member, women’s hopes should be treated with dignity and respect, and included in the perinatal care of women with abnormal fetuses. Further research is needed to improve the inclusion of women’s hopes in their care in clinical settings. Trial registration UMIN Clinical Trials Registry: UMIN000033622 (First registration date: 03/08/2018). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05115-x.
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17
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The Path Is Made by Walking-Mapping the Healthcare Pathways of Parents Continuing Pregnancy after a Severe Life-Limiting Fetal Diagnosis: A Qualitative Interview Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101555. [PMID: 36291491 PMCID: PMC9600615 DOI: 10.3390/children9101555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
In Germany, research on experiences and care pathways of parents continuing pregnancy after a life-limiting fetal diagnosis is scarce. There are several recommendations but few structured programs. We aimed to explore experiences and needs of parents, reconstruct their care pathways, and identify requirements for a perinatal palliative care program. We conducted semi-structured interviews with 11 mothers and 9 fathers and analyzed data using the Saldaña’s Coding Method. Codes were organized in templates to reconstruct care pathways. Pathways started with a suspicious finding prompting a referral to prenatal diagnostics. Parents experienced severe emotional distress during prenatal diagnostics due to scarce information, insensitiveness, and a perceived pressure towards abortion. As a result, they overlooked referrals to psychosocial counseling, generating a care gap. Most parents reached the decision to continue pregnancy without professional support. They then chose a trusted midwife or gynecologist as main caregiver during pregnancy. There were no regular referrals to palliative care, which mainly became relevant when the child survived. Our data indicate that a perinatal palliative care program requires early and comprehensive information, sensitivity, and a non-directive approach. Already existing support services need to be identified and connected through structured pathways, with a particular focus on midwives.
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18
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Yasar BN, Terzioglu F. Parents' Needs and Their Perceived Obstacles With Team Members in Perinatal Palliative Care: A Qualitative Phenomenological Study. J Hosp Palliat Nurs 2022; 24:00129191-990000000-00034. [PMID: 35881685 DOI: 10.1097/njh.0000000000000894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in prenatal diagnosis have made medical, psychological, and ethical issues regarding the diagnosis of fetal anomalies a crucial topic of research. This study identified the needs of parents of unborn babies with fetal anomalies and their views regarding the services of interdisciplinary team members in charge of assisting them. The sample consisted of 30 parents and 40 team members from a women's health education and research hospital. Data were collected through face-to-face interviews and were qualitatively analyzed using the phenomenological method of interpretation. The results showed that parents' physical, psychological, social, and spiritual needs during pregnancy, childbirth, and postpartum were not fully met after their unborn babies were diagnosed with fetal anomalies. The results also showed that team members needed a structured program, legal regulations, and training to provide holistic care.
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19
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Humphrey LM, Schlegel AB. Longitudinal Perinatal Palliative Care for Severe Fetal Neurologic Diagnoses. Semin Pediatr Neurol 2022; 42:100965. [PMID: 35868733 DOI: 10.1016/j.spen.2022.100965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
Perinatal palliative care (PnPC) focuses on enhancing family and newborn quality-of-life in the setting of a life-limiting fetal condition while simultaneously ensuring medical care delivery that is soundly in line with the family's goals and values. The inclusion of PnPC in the multidisciplinary care of a family facing severe fetal neurologic diagnoses allows for skilled exploration of the values and experience that ultimately drive creation of goals of care. The parental experience of receiving a life-limiting fetal diagnosis pushes parents into an emotional journey, which typically follows a recognizable progression of stages. PnPC providers appreciate the significance of this experiential journey and the importance of parental movement toward readiness to simultaneously welcome and mourn their child. Through longitudinal supportive care, beginning early in the fetal diagnostic progress and continuing throughout pregnancy and into the newborn period, PnPC providers explore the uncharted parental experience alongside the family and support them in creating value-driven care plans for their child. They contribute greatly to the multidisciplinary fetal and neonatal care teams as the advocate for and promote insightful communication and assist in delivery and coordination of value-driven care.
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Affiliation(s)
- Lisa M Humphrey
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Section of Hospice and Palliative Care, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH
| | - Amy B Schlegel
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.
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20
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Tataj-Puzyna U, Węgrzynowska M, Ryś M, Sys D, Bączek G, Baranowska B. "This pregnancy makes sense": Experiences of women who have decided to continue pregnancy after lethal fetal diagnosis. DEATH STUDIES 2022; 47:149-158. [PMID: 35201971 DOI: 10.1080/07481187.2022.2038310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lethal fetal diagnosis defines severe developmental disorders that lead to the death of a fetus or newborn. Using semi-structured interviews, we explored the experiences of women in Poland who actively decided to continue with the pregnancy after diagnosis. We thematically analyzed data collected from 10 women. We identified four themes: pregnancy as an experience of prenatal motherhood; the child as person; birth as encounter and farewell; and the mother experience in retrospect. This study was conducted while the termination of pregnancy due to the irreversible fetal abnormality was legal in Poland. Since October 2021, it is no longer legal.
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Affiliation(s)
- Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Ryś
- Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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21
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Côté-Arsenault D, Denney-Koelsch E, Elliott G. 'Creating a safe space': how perinatal palliative care coordinators navigate care and support for families. Int J Palliat Nurs 2021; 27:386-400. [PMID: 34672781 DOI: 10.12968/ijpn.2021.27.8.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Families who learn that their unborn baby has a life-limiting fetal condition are often overwhelmed by this news, alongside navigating an unfamiliar healthcare system. A skilled perinatal palliative care coordinator (PPCC) can help these families, yet little is known about their function and roles. AIMS This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care. METHODS This qualitative descriptive study included interviews of 12 expert PPCCs. Directed content analysis was used to identify major codes. Iterative analysis led to theme identification. FINDINGS Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning. CONCLUSIONS Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.
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Affiliation(s)
- Denise Côté-Arsenault
- Professor of Maternal Child Nursing, Trudy Busch Valentine School of Nursing, St. Louis University, St. Louis, MO, US
| | - Erin Denney-Koelsch
- Associate Professor, Division of Palliative Care, University of Rochester Medical Center, Rochester, NY, US
| | - Gail Elliott
- Assistant Professor of Nursing at Western Carolina University, US
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22
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Ren L, Song C, Xia C, Wang N, Yang Y, Yin S. Pregnancy and parenting experiences of women with twin-to-twin transfusion syndrome: a qualitative study. BMC Pregnancy Childbirth 2021; 21:595. [PMID: 34479507 PMCID: PMC8417964 DOI: 10.1186/s12884-021-04057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Qualitative research can reflect the actual thoughts and experience of research subjects and can be used to explore the experiences of women presenting with twin-to-twin transfusion syndrome (TTTS) to facilitate the provision of targeted psychological support. Methods A semi-structured interview method was used to assess the pregnancy and parenting experiences of women with TTTS. Colaizzi method was used for data analysis. Results Eighteen women participated in the study. We found that women with TTTS during pregnancy experienced persistent worry about their children’s health from the disease diagnosis to the subsequent parenting processes, even in case of minor changes in their children’s health. The lack of an efficient referral process and health information increased their uncertainty about their children’s health. Conclusion In addition to the children’s health, other difficulties encountered during pregnancy and parenting may aggravate the pressure. Clinicians in the first-visit hospital and foetal medicine centre should improve the referral process and establish a follow-up system to provide women with health information and psychological support. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04057-0.
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Affiliation(s)
- Lijie Ren
- Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China.,Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China
| | - Cancan Song
- Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China
| | - Chunling Xia
- Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China
| | - Nan Wang
- Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China
| | - Yan Yang
- Nursing Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China.
| | - Shaowei Yin
- Gynecology and Obstetrics Department, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang City, CO 110004, Liaoning Province, China.
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Abstract
Parents who choose to carry a pregnancy complicated by a life-limiting congenital anomaly such as anencephaly may give birth to a live neonate and be discharged home. Very little guidance is available to health care professionals providing palliative care in the home setting to this population. This article is a secondary analysis that discusses the concerns and complications that parents experienced after bringing home a neonate with anencephaly. Each parental experience is a qualitative descriptive summary extracted from a larger study on the impact of anencephaly on parents. Parents reported feeling alone in their grief and struggled with their partners' differing style of grief. Parents' primary concerns after hospital discharge included transporting their neonate home, feeding their neonate, changing cranial defect dressings, managing pain and seizures, addressing uncertainty, and facilitating a good death. All parents received hospice services from health care professionals without perinatal bereavement training or experience. Only 1 woman received follow-up care after the death of her son. Preparing and educating health care professionals providing hospice and palliative services with perinatal bereavement training may be beneficial. Identifying and allocating local and online perinatal bereavement resources may provide parents with the tools and support necessary to facilitate healing after perinatal loss.
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Affiliation(s)
- Shandeigh N Berry
- Shandeigh N. Berry, PhD, RN, CNOR, is assistant professor, College of Arts & Sciences, Saint Martin's University, Lacey, Washington
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24
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Denney-Koelsch E, Cote-Arsenault D. Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes. BMJ Support Palliat Care 2021:bmjspcare-2020-002857. [PMID: 34006514 PMCID: PMC8599500 DOI: 10.1136/bmjspcare-2020-002857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/12/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES When parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby. METHODS This study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents' experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison. RESULTS Thirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents' experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk-benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets. CONCLUSION For shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents' subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.
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25
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Berry SN, Severtsen B, Davis A, Nelson L, Hutti MH, Oneal G. The impact of anencephaly on parents: A mixed-methods study. DEATH STUDIES 2021; 46:2198-2207. [PMID: 33866956 DOI: 10.1080/07481187.2021.1909669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study used a convergent parallel mixed-method design to explore the impact of an anencephalic pregnancy on parents. Twenty women and four men between 18-59 years old participated. Interview transcripts were analyzed using interpretive phenomenology and synthesized with Perinatal Grief Intensity Scale scores using a Pearson's correlation. Overall, 75% of parents scored intense grief. Qualitative patterns included overwhelming trauma, patient-centeredness as critical, stigmatizing perinatal loss, embracing personhood, and reframing reality. Control over care was associated with decreased grief (p =.019). Health care professionals are ideally positioned to reduce the risk of intense grief in parents experiencing an anencephalic pregnancy.
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Affiliation(s)
- Shandeigh N Berry
- College of Arts & Sciences, Saint Martin's University, Olympia, Washington, USA
| | - Billie Severtsen
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Andra Davis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Lonnie Nelson
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Marianne H Hutti
- College of Nursing, University of Kentucky, Louisville, Kentucky, USA
| | - Gail Oneal
- College of Nursing, Washington State University, Spokane, Washington, USA
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26
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Women's Experiences With Palliative Care During Pregnancy. J Obstet Gynecol Neonatal Nurs 2021; 50:402-411. [PMID: 33775641 DOI: 10.1016/j.jogn.2021.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the experiences of women who received life-limiting fetal diagnoses during pregnancy and support from a perinatal palliative care program. DESIGN Descriptive qualitative. SETTING The perinatal palliative care program is part of a not-for-profit system of 24 hospitals serving the U.S. Intermountain West region. PARTICIPANTS A convenience sample of 12 women who experienced pregnancies with life-limiting fetal diagnoses and received care from a perinatal palliative care program. METHODS Women chose to participate from mailed invitations or responded to a post on private social media and then completed semistructured interviews about their experiences surrounding the fetal diagnoses and support from a perinatal palliative care program. Interviews were approximately 40 minutes in length and were conducted over the phone, recorded, and then transcribed. We performed content analysis by coding, forming categories of similar coded data, and constructing themes by recontextualizing categories through iterative, team-based meetings. RESULTS We identified four themes from the data: Importance of Memorabilia to Cope With the Death and Documentation of Pregnancy, Acceptance of Death as Part of the Pregnancy Experience, Continued Life Without a Child, and Importance of Empathy Throughout the Process. CONCLUSION The themes support the existing research findings about the needs of pregnant women as they cope with difficult situations. Our findings show the necessity and importance of perinatal palliative care programs.
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27
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Locatelli C, Corvaglia L, Simonazzi G, Bisulli M, Paolini L, Faldella G. "Percorso Giacomo": An Italian Innovative Service of Perinatal Palliative Care. Front Pediatr 2020; 8:589559. [PMID: 33330283 PMCID: PMC7710893 DOI: 10.3389/fped.2020.589559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
The perspective proposed by this article will focus on perinatal palliative care as a strategy for improving the quality of life of neonates with life-limiting conditions when extending the patient's life is no longer the goal of care. This manuscript reports the creation of an innovative program of perinatal palliative care called "Percorso Giacomo" (Giacomo's Pathway) at Sant'Orsola Hospital in Bologna, Italy in 2013. Key features include interdisciplinary collaboration between professionals from obstetrics, neonatology and other specialties aiming to reach the most detailed fetal and neonatal diagnosis and prognosis; communication and engagement with the family to discuss goals of care and prepare a birthing plan that follows the family's desires and expectations; and personalized care to achieve comfort for each newborn and support for families according to their social, cultural, and religious backgrounds.
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Affiliation(s)
- Chiara Locatelli
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maria Bisulli
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - Giacomo Faldella
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Berry SN, Marko T, Oneal G. Qualitative Interpretive Metasynthesis of Parents' Experiences of Perinatal Loss. J Obstet Gynecol Neonatal Nurs 2020; 50:20-29. [PMID: 33212051 DOI: 10.1016/j.jogn.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify and synthesize common, experiential themes from qualitative studies of parents who experienced perinatal loss. DATA SOURCES We searched PubMed, CINAHL, and PsycINFO for qualitative articles about parents' experiences of perinatal loss. STUDY SELECTION We included research on parents' experiences of perinatal loss published in English in the last 10 years. We excluded articles on the perspectives or experiences of health care professionals or persons other than the biological parent who experienced the perinatal loss, systematic reviews, outcome studies, and gray literature. DATA EXTRACTION We used a priori inclusion and exclusion criteria and identified five articles in which perinatal loss was described from the parents' perspectives. We extracted thematic findings and supporting quotes from each article and documented them in a table for subsequent synthesis. DATA SYNTHESIS We used a qualitative metasynthesis and interpretive model to synthesize findings from the included studies. Findings were synthesized into one overarching theme, The Paradox of Perinatal Loss, and four subthemes: Complex Emotional Responses, Prenatal Bonding-Acknowledging Personhood, Interactions With Health Care Professionals, and Traversing the Social Sphere. CONCLUSION Our findings indicate that perinatal loss is often a transformative event during which parents experience multiple losses and intense, complex emotions. Interactions with health care professionals greatly affected the pregnancy experience, which places professionals in a unique position to positively influence parents' overall experiences. Therefore, it is important to develop protocols related to perinatal loss and ensure that staff are adequately trained and equipped to care for parents during this experience. Findings from this synthesis may also inform the future development of theory related to bereavement surrounding perinatal loss.
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When Death Precedes Birth: The Embodied Experiences of Women with a History of Miscarriage or Stillbirth—A Phenomenological Study Using Artistic Inquiry. AMERICAN JOURNAL OF DANCE THERAPY 2020. [DOI: 10.1007/s10465-020-09340-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wool C, Parravicini E. The Neonatal Comfort Care Program: Origin and Growth Over 10 Years. Front Pediatr 2020; 8:588432. [PMID: 33194921 PMCID: PMC7661470 DOI: 10.3389/fped.2020.588432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/18/2020] [Indexed: 11/14/2022] Open
Abstract
The objective of perinatal palliative care is to provide holistic and comprehensive health care services to women who are anticipating the birth of a neonate diagnosed prenatally with a life-limiting condition and to continue supportive interventions for the mother and neonate after the birth. The nature of pregnancy, with two patients requiring medical care, requires clinicians from different specialties to engage with one another, the patient, and her chosen family members. Following birth, additional skill sets to treat the medical and comfort needs of the neonate, as well as the psychoemotional and medical needs of the mother, are required. An interdisciplinary team is necessary to assist families throughout the pregnancy and postnatal journey, and coordination of such care is an integral component of palliative care services. The number of palliative care programs is increasing, but little is written about the origins of such programs, their subsequent growth, and how transitions of care occur within the programs. In this publication, we will present data garnered from interdisciplinary team members of a single organization, the Neonatal Comfort Care Program at Columbia University Irving Medical Center, and how they provide care for families throughout the pregnancy and postnatal trajectory. We will address the origin and growth of the program, the development of the interdisciplinary team, and the strategies used for high-quality communication and their respective impact on care continuity. We will also provide specific recommendations from data gathered from team members, examine the role of formal and informal education, and identify barriers and future opportunities.
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Affiliation(s)
- Charlotte Wool
- York College of Pennsylvania, College of Nursing and Health Professions, York, PA, United States
| | - Elvira Parravicini
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
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A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions. Palliat Support Care 2020; 19:246-256. [PMID: 32867873 DOI: 10.1017/s1478951520000826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. METHOD Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. RESULTS A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. SIGNIFICANCE OF RESULTS The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
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Garten L, von der Hude K, Strahleck T, Krones T. Extending the Concept of Advance Care Planning to the Perinatal Period. KLINISCHE PADIATRIE 2020; 232:249-256. [PMID: 32542620 DOI: 10.1055/a-1179-0530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Easier access to prenatal diagnostic procedures led to its widespread use as a screening measure. Hence, today it is more common for life-limiting illnesses to be diagnosed during fetal life. The concept of Advance Care Planning (ACP) provides a framework for caregivers, families and their multidisciplinary teams to anticipate and plan ahead for potential future medical decisions so that the affected children are reliably treated according to their parents' individual values and wishes. In the perinatal context, ACP also has the potential to tackle the needs of unborn or newborn children with life-limiting illnesses and their families better, avoid unnecessary and burdensome measures and focus upon goals that are valuable and meaningful to both child and family.
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Affiliation(s)
- Lars Garten
- Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Strahleck
- Department of Neonatology and Neonatal Intensive Care, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Tanja Krones
- Institute of Biomedical Ethics and History of Medicine University of Zürich, University Hospital Zürich, Zürich, Switzerland
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Weeks A, Saya S, Hodgson J. Continuing a pregnancy after diagnosis of a lethal fetal abnormality: Views and perspectives of Australian health professionals and parents. Aust N Z J Obstet Gynaecol 2020; 60:746-752. [PMID: 32323315 DOI: 10.1111/ajo.13157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/24/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Couples who receive a prenatal diagnosis of a fetal anomaly in Victoria, Australia, are generally offered a choice about whether or not to continue with the pregnancy. When a severe or 'lethal' abnormality is diagnosed, some couples decide to continue the pregnancy in the knowledge that their baby may die before or shortly after birth. Several Australian parents who published personal accounts of that experience describe a lack of clear clinical pathways, suggesting those who decide to continue a pregnancy following a diagnosis of a 'lethal fetal abnormality' (LFA) may not be receiving optimal care. AIMS This study aimed to provide empirical Australian evidence of views and experiences of care provision from health professionals (HPs) and parents. MATERIALS AND METHODS Two sequential phases of this qualitative study purposively recruited a range of key HPs and parents. Semi-structured interviews were thematically analysed. RESULTS Findings reveal that current care provision following prenatal diagnosis of an LFA is 'ad hoc' with both participant groups identifying disparities between parents' needs and available care. However, the goodwill and good intentions of all HPs involved was apparent. There was strong support from both groups for considering a model of perinatal palliative care (PPC) based on existing programs overseas. CONCLUSIONS Future care provision in this setting needs to be redefined. A formal PPC program could ensure better and more consistent experiences of support for parents as well as the HPs working in the field.
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Affiliation(s)
- Alice Weeks
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sibel Saya
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jan Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Abstract
Perinatal palliative care refers to a coordinated care strategy that comprises options for obstetric and newborn care that include a focus on maximizing quality of life and comfort for newborns with a variety of conditions considered to be life-limiting in early infancy. With a dual focus on ameliorating suffering and honoring patient values, perinatal palliative care can be provided concurrently with life-prolonging treatment. The focus of this document, however, involves the provision of exclusively palliative care without intent to prolong life in the context of a life-limiting condition, otherwise known as perinatal palliative comfort care. Once a life-limiting diagnosis is suspected antenatally, the tenets of informed consent require that the pregnant patient be given information of sufficient depth and breadth to make an informed, voluntary choice for her care. Health care providers are encouraged to model effective, compassionate communication that respects patient cultural beliefs and values and to promote shared decision making with patients. Perinatal palliative comfort care is one of several options along a spectrum of care, which includes pregnancy termination (abortion) and full neonatal resuscitation and treatment, that should be presented to pregnant patients faced with pregnancies complicated by life-limiting fetal conditions. If a patient opts to pursue perinatal palliative comfort care, a multidisciplinary team should be identified with the infrastructure and support to administer this care. The perinatal palliative care team should prepare families for the possibility that there may be differences of opinion between family members before and after the delivery of the infant, and that there may be differences between parents and the neonatal care providers about appropriate postnatal therapies, especially if the postnatal diagnosis and prognosis differ substantially from antenatal predictions. Procedures for resolving such differences should be discussed with families ahead of time.
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Laza-Vásquez C, Cortés-Martínez KV, Cano-Rivillas JP. "It was God's will": Continuing pregnancy after perinatal infection by Zika virus. Rev Lat Am Enfermagem 2020; 28:e3310. [PMID: 32876288 PMCID: PMC7458580 DOI: 10.1590/1518-8345.3485.3310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/27/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the influence of the religious beliefs on the decision of a group of women residing in the Huila Department to continue their pregnancies despite perinatal infection by the Zika virus. METHOD a focused ethnography. The participants were 21 women who had presented a perinatal infection by the Zika virus and whose babies were born with congenital microcephaly. 2 discussion groups and 6 semi-structured interviews were conducted, and thematic analysis was used for data treatment. RESULTS three themes emerged, namely: "God, why me?" is the initial questioning of the women to God for the prenatal diagnosis of microcephaly in their babies, "Clinging to a divine miracle" describes how the women did not lose their faith and begged for a divine miracle for their babies to be born healthy, and "It was God's will" means acceptance, resignation, and respect for God's will, as well as the denial to abort despite the medical recommendations. CONCLUSION religiosity and religious beliefs were determinant factors in the women's decision to continue their pregnancies. It becomes necessary to continue investigating this theme to understand their experiences and to generate follow-up and support actions from nursing care.
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Affiliation(s)
- Celmira Laza-Vásquez
- Facultad de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, Cataluña, Spain
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Grauerholz KR, Fredenburg M, Jones PT, Jenkins KN. Fostering Vicarious Resilience for Perinatal Palliative Care Professionals. Front Pediatr 2020; 8:572933. [PMID: 33134232 PMCID: PMC7579417 DOI: 10.3389/fped.2020.572933] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 01/17/2023] Open
Abstract
Background: The demands on healthcare professionals caring for families grappling with a life-limiting condition in an unborn or newly born child can be overwhelming. Clinicians working in emergency/trauma, hospice, and pediatric settings are already at high risk for burnout and compassion fatigue, which can leave healthcare institutions increasingly vulnerable to poor retention, absenteeism, and waning quality of care. The provision of exemplary palliative care requires a cohesive interdisciplinary team of seasoned professionals resilient to daily challenges. In September 2019, the American College of Gynecology, in a committee opinion, published standard of care guidelines for perinatal palliative care. This has created an impetus for exceptional caregiving and a greater demand for both physician and interdisciplinary healthcare provider education, training, and ongoing support that promotes truly beneficent care for pregnant patients confronted with life-limiting fetal conditions. Methods: A scoping review of the research literature was conducted in order to distinguish the barriers and facilitators of professional resiliency in perinatal palliative care. PubMed, Medline, CINAHL, and EBSCO Psychology & Behavioral Sciences Collections were systematically reviewed. Because of the paucity of studies specific to perinatal palliative care, several interviews of nurses and physicians in that field were conducted and analyzed for content distinctly pertaining to personal practices or workplace factors that support or hinder professional resiliency. Results: The research indicated that medical professionals often cite a lack of knowledge, inexperience using effective communication skills related to perinatal palliative care and bereavement, challenges with interdisciplinary collaboration, misconceptions about the role and function of palliative care in the perinatal or neonatal settings, moral distress, and workload challenges as encumbrances to professional satisfaction. Strategic implementation of facility-wide bereavement care training, effective communication modalities, and evidenced-based practical applications are critical components for a thriving perinatal palliative care team. Authentic formal and informal debriefing, peer mentoring, adequate caseloads, robust provider self-care practices, exceptional relational efficacy, and cultural and spiritual humility can foster personal growth and even vicarious resilience for perinatal palliative care professionals. Conclusions: Support should be strategic and multifaceted. The onus to implement salient measures to cultivate resilience in the perinatal palliative caregiver should not be only upon the individuals themselves but also upon prevailing regulatory governing bodies and healthcare institutions.
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Affiliation(s)
| | | | - Premala Tara Jones
- Life Perspectives, San Diego, CA, United States.,Counseling and Testing Center, University of Akron, Akron, OH, United States
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37
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Marc-Aurele KL. Decisions Parents Make When Faced With Potentially Life-Limiting Fetal Diagnoses and the Importance of Perinatal Palliative Care. Front Pediatr 2020; 8:574556. [PMID: 33194903 PMCID: PMC7642456 DOI: 10.3389/fped.2020.574556] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/10/2020] [Indexed: 01/03/2023] Open
Abstract
When parents face a potentially life-limiting fetal diagnosis in pregnancy, they then have a series of decisions to make. These include confirmatory testing, termination, and additional choices if they choose to continue the pregnancy. A perinatal palliative team provides a safe, compassionate, and caring space for parents to process their emotions and discuss their values. In a shared decision-making model, the team explores how a family's faith, experiences, values, and perspectives shape the goals for care. For some families, terminating a pregnancy for any reason conflicts with their faith or values and pursuing life prolonging treatments in order to give their baby the best chances for survival is the most important. For others, having a postnatal confirmatory diagnosis of a life limiting or serious medical condition gives them the assurance they need to allow their child a natural death. Others want care to be comfort-focused in order to maximize the time they have to be together as a family. Through this journey, a perinatal palliative team can provide the support and encouragement for families to express their goals and wishes, as well as find meaning and hope.
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Affiliation(s)
- Krishelle L Marc-Aurele
- Division of Neonatology, Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
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38
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Cortezzo DE, Ellis K, Schlegel A. Perinatal Palliative Care Birth Planning as Advance Care Planning. Front Pediatr 2020; 8:556. [PMID: 33014940 PMCID: PMC7505922 DOI: 10.3389/fped.2020.00556] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose of Review: A significant number of pregnancies are complicated by a fetus with a life-limiting diagnosis. As diagnoses are made earlier in the pregnancy, families experience anticipatory grief and are faced with navigating goals of care for a baby that has yet to be born. With the support of the care team, families can begin to grieve, plan, and make meaningful memories during the duration of the pregnancy, the birth of their baby, and life of the child. Creating a palliative care birth plan, which expands beyond the traditional concept for delivery planning to include prenatal, perinatal, and neonatal care has become an important method for parents to process the diagnosis, for parents to document their wishes, and for members of the care team to communicate with the goal of supporting and enhancing the experience of the family. This articles reviews recent and relevant literature on the importance of birth planning and the role of perinatal palliative care when a life-limiting fetal diagnosis is made. Recent Findings: The process of birth planning is an important component of perinatal palliative care. Through this process, families can express their fears, values, hopes, and wishes. It also offers an opportunity for providers to communicate these wishes for the remainder of the pregnancy, the delivery, birth, and time afterwards. This has been demonstrated to decrease maternal stress and promote family centered care. Summary: Perinatal birth planning is an important component of perinatal palliative care when a fetus has a life-limiting diagnosis. The process of birth planning can be supportive and therapeutic as well as an important communication tool. With multiple practices and designs of perinatal palliative care programs, there are no standard tools even though important components have been identified. Ultimately, the strategies outlined here can be used as advance care planning tools.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kelstan Ellis
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, United States.,Section on Palliative Care, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Amy Schlegel
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, Ohio State University of Medicine, Columbus, OH, United States
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African American and Latino bereaved parent health outcomes after receiving perinatal palliative care: A comparative mixed methods case study. Appl Nurs Res 2019; 50:151200. [PMID: 31735485 DOI: 10.1016/j.apnr.2019.151200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/19/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Death of one's infant is devastating to parents, negatively impacting couple relationships and their own health. The impact of a prenatally diagnosed life-limiting fetal condition (LLFC) on parents of minority status is unclear. AIM This comparative mixed methods case study examined the person characteristics, quality of perinatal palliative care (PPC) received and parent health outcomes. METHODS Bereaved couples, 11 mothers and 3 fathers of minority or mixed races (11 African American and Latino, 1 White Latino and 2 White parents) completed the survey; 7 were interviewed. RESULTS Parents rated their general health close to good, physical health close to normal but mental health lower than the population norm. Clinical caseness (abnormal levels) of anxiety were reported in 50% of parents whereas depression scores were normal. The experience of fetal diagnosis and infant death had a negative impact on the health of 40% of participants however, parents could not identify what specifically caused their health problems. Most were satisfied with their PPC but some shared that original providers were not supportive of pregnancy continuation. After the baby's death, 71% reported closer/stronger couple relationships. Two contrasting cases are presented. Once parents found PPC, their baby was treated as a person, they spent time with their baby after birth, and found ways to make meaning through continuing bonds. CONCLUSION Despite high overall satisfaction with PPC, bereaved parents were deeply impacted by their infant's death. Mixed methods case study design illuminated the complicated journeys of parents continuing their pregnancy with a LLFC.
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40
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Doherty ME, Power L, Williams R, Stoppels N, Grandmaison Dumond L. Experiences from the first 10 years of a perinatal palliative care program: A retrospective chart review. Paediatr Child Health 2019; 26:e11-e16. [PMID: 33542774 DOI: 10.1093/pch/pxz089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Perinatal palliative care is a relatively new component of paediatric palliative care which supports families who are expecting the birth of a child with a life-limiting condition. This study seeks to understand the characteristics of the infants and families referred for perinatal palliative care and the context for referrals in terms of diagnoses, referral characteristics, interventions, and outcomes. Methods A retrospective chart review of infants with prenatally diagnosed life-limiting conditions that were referred for perinatal palliative care. Results Eighty-five referrals were made for perinatal palliative care during the 10-year period, of which, 84 chose to continue with the service. Average gestational age at diagnosis was 23 weeks, and the mean time between diagnosis and referral to palliative care was 7 weeks. Stillbirths were common, occurring in 29% cases. Of livebirths, 59% of the infants survived for 2 days, and 80% died within 30 days. The most commonly referred conditions were trisomy 13 or 18 (24%), severe central nervous system malformations (20%), and severe congenital cardiac disease (16%). Referrals were most often made by neonatologists (39%), and maternal-fetal medicine specialists (36%). Discussion Our study confirms previously observed characteristics of diagnosis, referrals, and outcomes, while providing the most detailed account of lifespans for particular diagnoses to date. Our findings validate the need for perinatal palliative care, as 99% of those referred continued with the service. Future research should adopt a prospective approach to identify critical factors affecting decision making of families and physicians in the wake of a life-limiting diagnosis.
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Affiliation(s)
- Megan E Doherty
- Children's Hospital of Eastern Ontario - Pediatrics, Ottawa, Ontario
| | | | - Robin Williams
- Horizon Health Network - Palliative Medicine, Saint John, New Brunswick
| | - Nahal Stoppels
- Children's Hospital of Eastern Ontario - Palliative Care Program, Ottawa, Ontario
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Tiemeyer S, Shreffler K, McQuillan J. Pregnancy happiness: implications of prior loss and pregnancy intendedness. J Reprod Infant Psychol 2019. [PMID: 31271303 DOI: 10.1080/02646838.2019.1636944.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.
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Affiliation(s)
- Stacy Tiemeyer
- Department of Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Karina Shreffler
- Department of Human Development and Family Science, Oklahoma State University, Stillwater, USA
| | - Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
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42
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Tiemeyer S, Shreffler K, McQuillan J. Pregnancy happiness: implications of prior loss and pregnancy intendedness. J Reprod Infant Psychol 2019; 38:184-198. [PMID: 31271303 DOI: 10.1080/02646838.2019.1636944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women's happiness about a subsequent pregnancy.Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings about a subsequent birth.Methods: Using data from the 2002-2013 National Survey of Family Growth (NSFG), we used logistic regression analyses to explore the implications of a prior pregnancy loss for happiness about a subsequent pregnancy that ends in a live birth. We compared births classified as on-time, mistimed, unwanted, and ambivalent.Results: Births were more likely to be characterised as on-time if they occurred following a pregnancy loss, and women were less likely to report being happy about a conception if they were ambivalent about the conception and experienced a previous loss. Overall, pregnancy loss alone was not associated with lower levels of happiness about a subsequent birth.Conclusions: Pregnancy loss can be a highly distressing experience, women's happiness about a subsequent pregnancy is not reduced due to prior pregnancy loss. Future research should explore why women who were ambivalent about pregnancy reported lower levels of happiness following a loss.
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Affiliation(s)
- Stacy Tiemeyer
- Department of Human Development and Family Science, Oklahoma State University, Tulsa, OK, USA
| | - Karina Shreffler
- Department of Human Development and Family Science, Oklahoma State University, Stillwater, USA
| | - Julia McQuillan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Flaig F, Lotz JD, Knochel K, Borasio GD, Führer M, Hein K. Perinatal Palliative Care: A qualitative study evaluating the perspectives of pregnancy counselors. Palliat Med 2019; 33:704-711. [PMID: 30843464 PMCID: PMC6535800 DOI: 10.1177/0269216319834225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A prenatal diagnosis of a life-limiting disease raises complex ethical, emotional, and medical issues. Studies suggest that 40%-85% of parents decide to continue the pregnancy if given the option of Perinatal Palliative Care. However, structured Perinatal Palliative Care programs are missing in many European countries. In Germany, parents have the right to free psychosocial support from pregnancy counseling services after the prenatal diagnosis of a life-limiting disease. AIM We aimed to investigate whether German professional pregnancy counselors perceive the need for structured Perinatal Palliative Care and if so, how it should be conceived. DESIGN This is a qualitative interview study with purposeful sampling. The interviews were analyzed with the coding method of Saldaña. SETTING/PARTICIPANTS A total of 10 professionals from three different pregnancy counseling services participated in the study. RESULTS The main topics raised by the professionals were as follows: (1) counseling and parental support during the decision-making process; (2) fragmented or missing support infrastructure for parents; and (3) challenges, hesitations, and barriers, particularly from the different stakeholders, regarding a Perinatal Palliative Care framework. They highlighted the importance of the integration of Perinatal Palliative Care in existing structures, a multi-professional approach, continuous coordination of care and education for all healthcare providers involved. CONCLUSION A structured Perinatal Palliative Care program is considered as necessary by the pregnancy counselors. Future research should focus on (1) needs reported by concerned parents; (2) attitude and role of all healthcare providers involved; (3) strategies to include stakeholders in the development of Perinatal Palliative Care networks; and (4) outcome parameters for evaluation of Perinatal Palliative Care frameworks.
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Affiliation(s)
- Franziska Flaig
- 1 Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Germany
| | - Julia D Lotz
- 1 Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Germany
| | - Kathrin Knochel
- 1 Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Germany
| | - Gian Domenico Borasio
- 2 Palliative Care Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika Führer
- 1 Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Germany
| | - Kerstin Hein
- 1 Center for Pediatric Palliative Care, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Germany
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Åhman A, Edvardsson K, Fagerli TA, Darj E, Holmlund S, Small R, Mogren I. A much valued tool that also brings ethical dilemmas - a qualitative study of Norwegian midwives' experiences and views on the role of obstetric ultrasound. BMC Pregnancy Childbirth 2019; 19:33. [PMID: 30651083 PMCID: PMC6335783 DOI: 10.1186/s12884-019-2178-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 01/04/2019] [Indexed: 02/03/2023] Open
Abstract
Background Midwives are the main providers of routine antenatal care services including the routine ultrasound examination in Norway. The ultrasound examination can be perceived by expectant parents not only as a medical examination but also as a social event facilitating attachment to their fetus. This study explores Norwegian midwives’ experiences and views on the role of ultrasound in clinical management of pregnancy. Methods A qualitative study design was applied. Twenty-four midwives who all performed obstetric ultrasound examinations were recruited for focus group discussions and individual interviews. Data collection took place in 2015 in five hospitals in two different regions of Norway. Data were analyzed using qualitative content analysis. Results Midwives described obstetric ultrasound examinations as very valuable although doing ultrasounds placed high demands on their operational and counselling skills. Increasing requests for ultrasound from pregnant women were mentioned. Advancements in ultrasound diagnosis were considered to have put the fetus in the position of a patient, and that pregnant women declining ultrasound could be viewed as irresponsible by some health professionals. Ethical concerns were raised regarding the possibility of pregnancy termination when fetal anomalies were detected. Fears were also expressed that prenatal diagnoses including those following ultrasound, might create a society where only ‘perfect’ children are valued. However, participants stressed that their intention in performing ultrasound was to optimize pregnancy outcome and thereby assist expectant couples and their unborn children. Conclusions Midwives in Norwegian maternity care services describe obstetric ultrasound as very valuable, playing a central role in pregnancy management by optimizing pregnancy outcomes. Although high demands are placed on operators’ technical skills and counseling, midwives described performing obstetric ultrasound as very satisfying work. However, midwives believed that expectant parents’ approach to the ultrasound examination, both its medical value and the precious images obtained of the fetus, could put extra strain on the midwives performing ultrasounds. The potential of ultrasound to detect fetal anomalies and the possibility that this may lead to termination of pregnancy, seemed to create some ambivalent feelings in midwives towards its use. Electronic supplementary material The online version of this article (10.1186/s12884-019-2178-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Åhman
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden
| | - Kristina Edvardsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden. .,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Tove Anita Fagerli
- National Center for Fetal Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Darj
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.,Reproductive Health, Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87, Umeå, Sweden.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
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Anencephaly; the maternal experience of continuing with the pregnancy. Incompatible with life but not with love. Midwifery 2018; 71:12-18. [PMID: 30640134 DOI: 10.1016/j.midw.2018.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE As advances in prenatal diagnosis increasingly enable detection of life-limiting conditions, end-of-life care may start before birth. Termination of these pregnancies may have been default management, but in the Republic of Ireland, where termination is not a legal option, skilled experience in caring for mothers who continue their pregnancies has developed. This study examines the lived experience of four such mothers. METHOD A qualitative study was designed using interpretive phenomenological analysis, which examined the maternal experience of continuing pregnancy with a prenatal diagnosis of anencephaly. Four mothers participated in semi-structured interviews on their experience of pregnancy and delivery of a baby with anencephaly. RESULTS A profoundly emotional journey represented an adaptive grieving process, which culminated in rich experiences of transformative growth for all the parents. The parents' relationship with their caregivers facilitated this process and the development of a meaningful parenting relationship with their babies. This positive finding coexists alongside a parallel experience of ongoing deep sense of loss and sadness. CONCLUSION Perinatal palliative care for those with a prenatal lethal diagnosis is a positive life experience for some mothers. The role of relationship with healthcare professionals is vital to the process and consideration must be given to a comprehensive multi-disciplinary team approach.
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Kamrath HJ, Osterholm E, Stover-Haney R, George T, O'Connor-Von S, Needle J. Lasting Legacy: Maternal Perspectives of Perinatal Palliative Care. J Palliat Med 2018; 22:310-315. [PMID: 30388063 DOI: 10.1089/jpm.2018.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Many of the leading causes of infant mortality are diagnosed prenatally, presenting providers with the ability to present perinatal palliative care planning as an option. OBJECTIVE Our study adds to the literature both by describing infant interaction with the health care system and by gaining deeper understanding of the maternal experience after being offered perinatal palliative care. METHODS The study was conducted at a public university-based medical center in the Midwest. Phase 1 consisted of a retrospective review of electronic medical records of 27 mother-infant pairs offered perinatal palliative care, 18 of whom elected to develop a perinatal palliative care. Phase 2 consisted of a focus group and interviews of seven of the mothers. RESULTS In the initial phase of this study, results revealed differences regarding the infant's end-of-life trajectory, including location of death, number of invasive procedures, and death in the setting of withholding versus withdrawing life-sustaining treatment. Highlighting that without a perinatal palliative care plan in place, the default treatment for infants with prenatally diagnosed life-limiting conditions is likely to be invasive and painful with often times minimal likelihood of long-term survival. Analysis of interview and focus group data revealed three themes: care, choice, and legacy. CONCLUSION The authors used their experience with the health care system to draw implications for practice from the focus group and interview data, which care can serve to promote women feeling cared for and cared about, as well as promote opportunities for hope during a fragile pregnancy.
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Affiliation(s)
- Heidi J Kamrath
- 1 Children's Hospitals and Clinics of Minnesota , St. Paul, Minnesota
| | - Erin Osterholm
- 2 Department of Pediatrics, University of Minnesota , Minneapolis, Minnesota
| | | | - Thomas George
- 2 Department of Pediatrics, University of Minnesota , Minneapolis, Minnesota
| | - Susan O'Connor-Von
- 2 Department of Pediatrics, University of Minnesota , Minneapolis, Minnesota
| | - Jennifer Needle
- 2 Department of Pediatrics, University of Minnesota , Minneapolis, Minnesota
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Wool C, Limbo R, Denney-Koelsch EM. “I Would Do It All Over Again”: Cherishing Time and the Absence of Regret in Continuing a Pregnancy after a Life-Limiting Diagnosis. THE JOURNAL OF CLINICAL ETHICS 2018. [DOI: 10.1086/jce2018293227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Emotional Effect of the Loss of One or Both Fetuses in a Monochorionic Twin Pregnancy. J Obstet Gynecol Neonatal Nurs 2018; 47:137-145. [DOI: 10.1016/j.jogn.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 10/18/2022] Open
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Abstract
ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family. Herein we explore a range of ethical considerations that may be encountered when caring for a patient on ECMO, with a particular focus on those courses where it appears likely that the patient will not survive. We then consider how a palliative care approach may provide a tool set to help engage the team and family in confronting the difficult decision to discontinue ECMO.
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Affiliation(s)
- Roxanne Kirsch
- Department of Critical Care, The Hospital for Sick Children, Toronto, Canada; Department of Bioethics, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada.
| | - David Munson
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA
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Pediatric Palliative Care in Infants and Neonates. CHILDREN-BASEL 2018; 5:children5020021. [PMID: 29414846 PMCID: PMC5835990 DOI: 10.3390/children5020021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 01/26/2023]
Abstract
The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns' short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely. While neonatology service capacity has grown worldwide during this time, so has attention to pediatric palliative care generally, and neonatal-perinatal palliative care specifically. Improvements have occurred in family-centered care, communication, pain assessment and management, and bereavement. There remains a need to integrate palliative care with intensive care rather than await its application solely at the terminal phase of a young infant's life-when s/he is imminently dying. Future considerations for applying neonatal palliative care include its integration into fetal diagnostic management, the developing era of genomic medicine, and expanding research into palliative care models and practices in the NICU.
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