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Dandy S, Wittkowski A, Murray CD. Parents' experiences of receiving their child's diagnosis of congenital heart disease: A systematic review and meta-synthesis of the qualitative literature. Br J Health Psychol 2024; 29:351-378. [PMID: 37968248 DOI: 10.1111/bjhp.12703] [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: 03/03/2023] [Revised: 07/31/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This systematic review aimed to synthesize qualitative research on parents' psychological experiences following their child's diagnosis of congenital heart disease (CHD). METHODS A systematic search of six electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed and Web of Science) was completed, inclusive of all years up to May 2022. Any included articles were synthesized using thematic synthesis and appraised using the Critical Appraisal Skills Programme Qualitative Checklist. RESULTS Twenty-six articles were included. Four main themes, and 11 subthemes, emerged from the synthesis. Theme 1 (unpreparedness for the diagnosis) concerned parents' shock, guilt and anger regarding the diagnosis. Theme 2 (the overwhelming reality of CHD) described parental fear about decision-making and the child's prognosis, and the influence of professionals on parents' well-being. Theme 3 (mourning multiple losses) detailed parents' sadness at losing their envisioned pregnancy, birth and parenthood experiences. Theme 4 (redefining hopes to reach an acceptance of CHD) described parents' adjustment to the diagnosis. CONCLUSIONS Receiving a child's CHD diagnosis was a uniquely challenging situation for parents. The findings provided insight into the emotions parents experienced and how they adjusted to the diagnosis psychologically. As parents' experiences were significantly influenced by their interactions with professionals, clinicians should offer compassion, validation and clear information throughout the diagnosis process.
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Lin M, Rholl E, Andescavage N, Ackerman O, Fisher D, Lanzel AF, Mahmood LA. Improving Prenatal Palliative Care Consultation Using Diagnostic Trigger Criteria. J Pain Symptom Manage 2024; 67:e137-e145. [PMID: 37858635 DOI: 10.1016/j.jpainsymman.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Three percent of pregnancies are complicated by congenital anomalies. Prenatal integration of pediatric palliative care (PPC) may be hindered by non-standardized PPC referral processes. This quality improvement (QI) project aimed to improve prenatal PPC consultation using a diagnostic trigger list. MEASURES Main outcome measure was the percentage of prenatal PPC consults completed based on diagnostic trigger list eligibility. Balancing measures included stakeholder perspectives on PPC consults and products. INTERVENTION Interventions included creation and implementation of a diagnostic trigger list for prenatal PPC consultation, educational initiatives with stakeholders, and iterative modifications of our prenatal consultation process. OUTCOMES Interventions increased consultation rates ≥80% during the first six months of QI implementation (baseline vs. post-interventions) although this increase was not consistently sustained over a 12-month period. CONCLUSIONS/LESSONS LEARNED Diagnostic trigger lists improve initial rates of prenatal PPC consultation and additional interventions are likely needed to sustain this increase.
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Affiliation(s)
- Matthew Lin
- Division of Neonatology (M.L.), Department of Pediatrics, New York University School of Medicine, New York, New York, USA.
| | - Erin Rholl
- Division of Neonatology (E.R.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nickie Andescavage
- Division of Neonatology (N.A.), Children's National Hospital, Washington, District of Columbia, USA; School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA
| | - Olivia Ackerman
- Prenatal Pediatrics Institute (O.A.), Children's National Hospital, Washington, District of Columbia, USA
| | - Deborah Fisher
- School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA
| | - Ashley F Lanzel
- School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA
| | - Laila A Mahmood
- School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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Habet V, Teele SA. Communication challenges: perioperative risks and care directives. Curr Opin Cardiol 2023; 38:375-379. [PMID: 37016950 DOI: 10.1097/hco.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
PURPOSE OF REVIEW Effective communication and shared decision-making is crucial in caring for children with congenital or acquired heart disease. Despite high mortality, complications related to interventions, and suffering in pediatric advanced heart disease, there is a disproportionate lack of research and advancements in communication and shared decision-making surrounding perioperative risks and advance care planning. We have comprehensively reviewed recent research on this multifaceted topic in the past 1.5 years to highlight major findings and propose priorities for future research. RECENT FINDINGS Research has focused on parental perception of clinician/team communication with a notable paucity of research investigating the clinician perception of barriers to effective communication. Although there are discrepancies between parental and clinician perception, lack of trust between the patient's family and provider was acknowledged as a barrier by both parents and clinicians. Insight into interprofessional needs and expansion of structured language for discussions around shared decision-making should be prioritized. SUMMARY Clinician discomfort with communication skills and conveying uncertainty in prognosis are two major areas for future research. On the basis of the literature to date, the focus should be placed on interprofessional needs and structured language for discussions around shared decision-making.
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Affiliation(s)
- Victoria Habet
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Delaney RK, Thorpe A, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Tanner K, Fagerlin A. Parents' quality of life and health after treatment decision for a fetus with severe congenital heart defect. J Pediatr Nurs 2023; 70:20-25. [PMID: 36791586 PMCID: PMC10182246 DOI: 10.1016/j.pedn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This exploratory study examines differences in parents' quality of life by treatment decision and the child's survival outcome in the context of life-threatening congenital heart disease (CHD). DESIGN AND METHODS Parents of a fetus or neonate diagnosed with severe CHD enrolled in the observational control group of a clinical trial (NCT04437069) and completed quality of life (i.e., contact with clinicians, social support, partner relationship, state of mind), mental and physical health survey measures. Comparisons were made between parents who chose comfort-directed care or surgery and between those whose child did and did not survive. RESULTS Parents who chose surgery and their child did not survive reported the most contact with their clinicians. Parents who chose comfort-directed care reported lower social support than parents who chose surgery and their child did not survive as well as poorer state of mind compared to parents who chose surgery. CONCLUSIONS Some aspects of parents' quality of life differed based on their treatment decision. Parents who choose comfort-directed care are vulnerable to some negative outcomes. PRACTICE IMPLICATIONS Decision support tools and bereavement resources to assist parents with making and coping with a complex treatment decision is important for clinical care.
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Affiliation(s)
- Rebecca K Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA.
| | - Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Elissa M Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Mandy L Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Lisa M Hansen
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Linda M Lambert
- Department of Pediatrics, University of Utah, Salt Lake City, USA
| | - Kirstin Tanner
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, University of Utah Health, Salt Lake City, USA; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, USA.
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Sable C, Li JS, Tristani‐Firouzi M, Fagerlin A, Silver RM, Yandel M, Yost HJ, Beaton A, Dale J, Engel ME, Watkins D, Spurney C, Skinner AC, Armstrong SC, Shah SH, Allen N, Davis M, Hou L, Van Horn L, Labarthe D, Lloyd‐Jones D, Marino B. American Heart Association's Children's Strategically Focused Research Network Experience. J Am Heart Assoc 2023; 12:e028356. [PMID: 36974754 PMCID: PMC10122897 DOI: 10.1161/jaha.122.028356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The American Heart Association's Strategically Focused Children's Research Network started in July 2017 with 4 unique programs at Children's National Hospital in Washington, DC; Duke University in Durham, North Carolina; University of Utah in Salt Lake City, Utah; and Lurie Children's Hospital/Northwestern University in Chicago, Illinois. The overarching goal of the Children's National center was to develop evidence-based strategies to strengthen the health system response to rheumatic heart disease through synergistic basic, clinical, and population science research. The overall goals of the Duke center were to determine risk factors for obesity and response to treatment including those that might work on a larger scale in communities across the country. The integrating theme of the Utah center focused on leveraging big data-science approaches to improve the quality of care and outcomes for children with congenital heart defects, within the context of the patient and their family. The overarching hypothesis of the Northwestern center is that the early course of change in cardiovascular health, from birth onward, reflects factors that result in either subsequent development of cardiovascular risk or preservation of lifetime favorable cardiovascular health. All 4 centers exceeded the original goals of research productivity, fellow training, and collaboration. This article describes details of these accomplishments and highlights challenges, especially around the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Norrina Allen
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Matthew Davis
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Lifang Hou
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Linda Van Horn
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Darwin Labarthe
- Northwestern University Feinberg School of MedicineChicagoILUSA
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Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA, Machado D, Peyton C, Bacha E, Morell E. Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000114. [PMID: 36633003 PMCID: PMC10472747 DOI: 10.1161/hcq.0000000000000114] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. METHODS A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.
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Delaney RK, Pinto NM, Ozanne EM, Stark LA, Pershing ML, Thorpe A, Witteman HO, Thokala P, Lambert LM, Hansen LM, Greene TH, Fagerlin A. Study protocol for a randomised clinical trial of a decision aid and values clarification method for parents of a fetus or neonate diagnosed with a life-threatening congenital heart defect. BMJ Open 2021; 11:e055455. [PMID: 34893487 PMCID: PMC8666895 DOI: 10.1136/bmjopen-2021-055455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Parents who receive the diagnosis of a life-threatening, complex heart defect in their fetus or neonate face a difficult choice between pursuing termination (for fetal diagnoses), palliative care or complex surgical interventions. Shared decision making (SDM) is recommended in clinical contexts where there is clinical equipoise. SDM can be facilitated by decision aids. The International Patient Decision Aids Standards collaboration recommends the inclusion of values clarification methods (VCMs), yet little evidence exists concerning the incremental impact of VCMs on patient or surrogate decision making. This protocol describes a randomised clinical trial to evaluate the effect of a decision aid (with and without a VCM) on parental mental health and decision making within a clinical encounter. METHODS AND ANALYSIS Parents who have a fetus or neonate diagnosed with one of six complex congenital heart defects at a single tertiary centre will be recruited. Data collection for the prospective observational control group was conducted September 2018 to December 2020 (N=35) and data collection for two intervention groups is ongoing (began October 2020). At least 100 participants will be randomised 1:1 to two intervention groups (decision aid only vs decision aid with VCM). For the intervention groups, data will be collected at four time points: (1) at diagnosis, (2) postreceipt of decision aid, (3) postdecision and (4) 3 months postdecision. Data collection for the control group was the same, except they did not receive a survey at time 2. Linear mixed effects models will assess differences between study arms in distress (primary outcome), grief and decision quality (secondary outcomes) at 3-month post-treatment decision. ETHICS AND DISSEMINATION This study was approved by the University of Utah Institutional Review Board. Study findings have and will continue to be presented at national conferences and within scientific research journals. TRIAL REGISTRATION NUMBER NCT04437069 (Pre-results).
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Affiliation(s)
- Rebecca K Delaney
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nelangi M Pinto
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Elissa M Ozanne
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Louisa A Stark
- Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mandy L Pershing
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alistair Thorpe
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Holly O Witteman
- Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Linda M Lambert
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Lisa M Hansen
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tom H Greene
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
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