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McKechnie AC, Elgersma KM, Iwaszko Wagner T, Trebilcock A, Damico J, Sosa A, Ambrose MB, Shah K, Sanchez Mejia AA, Pridham KF. An mHealth, patient engagement approach to understand and address parents' mental health and caregiving needs after prenatal diagnosis of critical congenital heart disease. PEC INNOVATION 2023; 3:100213. [PMID: 37771461 PMCID: PMC10523263 DOI: 10.1016/j.pecinn.2023.100213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
Objective To provide an overview of the development of the Preparing Heart and Mind™ (PHM™) care program designed for parents with a prenatal diagnosis of critical congenital heart disease (CCHD) and describe issues of parental concern, caregiving competencies, and type and timing of PHM™ topics. Methods Guided participation theory underpinned intervention development and a mixed methods pilot of a novel, nurse-guided mHealth intervention. Parents were enrolled from the third trimester of pregnancy-12 weeks postnatally. Online surveys, session transcripts, and app use were descriptively analyzed. Results The sample included 19 mothers/birthing persons and 15 caregiving partners randomized to the intervention group. In 49 sessions, mental health/wellbeing (94%) and condition-specific information (86%) were top issues. Many caregiving competencies were developed, with mothers/birthing persons often focused on feeding (86%). Regulating emotions and co-parenting consistently needed support. PHM™ topics of preparing for hospitalization (47%) and handling uncertainty (45%) were most discussed. Two cases further characterize findings. Conclusion Nurse-parent collaborative understanding of issues emphasized the need for mental health assessments. Prenatal intervention opportunities were underscored through discussions of caregiving issues and PHM™ topics. Innovation PHM™ represents an innovative approach that holds promise for supporting parents' mental health and caregiving needs outside the healthcare setting.
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Affiliation(s)
| | - Kristin M. Elgersma
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Taylor Iwaszko Wagner
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Anna Trebilcock
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Jenna Damico
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Alejandra Sosa
- School of Nursing, Child and Family Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthew B. Ambrose
- Medical School, Pediatrics-Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Kavisha Shah
- Medical School, Pediatrics-Cardiology, University of Minnesota, Minneapolis, MN, USA
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Ross S, Verstappen A. The Role of Congenital Heart Disease Patient Organizations in Advocacy, Resources, and Support Across the Lifespan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:256-266. [PMID: 38161679 PMCID: PMC10755777 DOI: 10.1016/j.cjcpc.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024]
Abstract
Congenital heart disease patient organizations, comprising experts with lived experience, and their families and supporters, have become an essential voice for patient advocacy, resources, and support. Thanks largely to the Internet, these organizations are growing in number worldwide. Their common voice can be used to influence research, be the catalyst for advocacy efforts for new programmes and supports, and connect patients and providers in endeavours beyond the clinical setting. The result has become more active engagement with how policy decisions, research directions, and laws are decided that will shape patients' lives. From advocating for much-needed mental health support, policies to combat discrimination and the lack of access to support services, and partnerships with clinicians and others to develop educational resources and tools, congenital heart disease patient organizations are having a considerable impact on patient lives and ultimately patient outcomes.
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Affiliation(s)
- Shelagh Ross
- Global Alliance for Rheumatic & Congenital Hearts (Global ARCH), Victoria, British Columbia, Canada
| | - Amy Verstappen
- Global Alliance for Rheumatic & Congenital Hearts (Global ARCH), Philadelphia, Pennsylvania, USA
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Sood E, Nees SN, Srivastava S, Ng S, Torres C, Munoz Osorio A, Canter KS, Braley KT, Spradley L, Stein J, Riegel E, Kazak AE. Virtually Delivered Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease: Feasibility and Acceptability of HEARTPrep. Pediatr Cardiol 2023; 44:1479-1486. [PMID: 37355506 PMCID: PMC10758983 DOI: 10.1007/s00246-023-03209-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Prenatal diagnosis of congenital heart disease (CHD) often leads to anxiety, depression, and traumatic stress in expectant mothers, with long-term implications for the child and family. However, psychosocial intervention is rarely incorporated into prenatal care. HEARTPrep is a virtually delivered psychosocial intervention aimed at reducing distress and social isolation and increasing parenting self-efficacy and hope for mothers expecting a baby with CHD to promote long-term child/family well-being. This study evaluated the feasibility and acceptability of HEARTPrep. Participants were mothers receiving cardiology care for a fetal CHD diagnosis. Partners could participate with the mother. HEARTPrep was delivered through a mobile app and telehealth. Feasibility was assessed through enrollment/retention rates. Acceptability was assessed through 20 Likert-scale and five open-ended questions. Of 39 recruited mothers, 35 (90%) enrolled. Half of partners (48%) also participated. Twenty-seven of 35 enrolled mothers (77%) completed HEARTPrep. On a scale from 0 (Not at All) to 4 (Very), mean item acceptability scores ranged from 3.5 to 3.9. Mothers reported HEARTPrep helped them feel less distressed (mean: 3.74), less alone (3.84), more prepared (3.89), and more hopeful (3.84). Opportunities to process emotions, develop coping skills, learn with their partner, navigate relationships, understand they are not alone, connect with peer support, access resources, and prepare for stressors were described as helpful. HEARTPrep is feasible and acceptable for mothers expecting a baby with CHD. Future research will evaluate its efficacy in preventing/reducing maternal mental health problems and improving postnatal clinical outcomes.
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Affiliation(s)
- Erica Sood
- Department of Research, Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, DE, USA.
- Division of Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE, USA.
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Shannon N Nees
- Division of Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Shubhika Srivastava
- Division of Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephanie Ng
- Division of Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE, USA
| | - Cynthia Torres
- Division of Psychology, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
| | - Angel Munoz Osorio
- Department of Research, Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, DE, USA
| | - Kimberly S Canter
- Department of Research, Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Katherine T Braley
- Divison of Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Orlando, FL, USA
| | - Lisa Spradley
- Maternal Fetal Medicine, Center for Fetal Care, Nemours Children's Hospital, Orlando, FL, USA
| | - Jennifer Stein
- Maternal Fetal Medicine, Center for Fetal Care, Nemours Children's Hospital, Orlando, FL, USA
| | - Erin Riegel
- Conquering CHD-Delaware, Wilmington, DE, USA
| | - Anne E Kazak
- Department of Research, Center for Healthcare Delivery Science, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Martens AM, Lim CC, Kelly M, Haxel CS, Ronai C, Chiu JS. Evaluating How Physician Attitudes May Affect Practice in Fetal Cardiac Counseling. Pediatr Cardiol 2023:10.1007/s00246-023-03210-0. [PMID: 37335356 DOI: 10.1007/s00246-023-03210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
Advances in fetal cardiac imaging over the last few decades have allowed for increased prenatal detection and detailed counseling of congenital heart disease (CHD). When CHD is detected, fetal cardiologists are faced with the challenge of providing nuanced prenatal counseling. Studies in other specialties have shown that differences in physician attitudes exist around termination of pregnancy and correlate with variations in the counseling provided to parents. We conducted an anonymous cross-sectional survey of fetal cardiologists in New England (n = 36) regarding attitudes toward termination of pregnancy and the counseling provided to parents with a fetal diagnosis of hypoplastic left heart syndrome. Using a screening questionnaire, there was no significant difference in the counseling provided to parents regardless of the physician's personal or professional views on termination of pregnancy, age, gender, location, type of practice, or years of experience. There were, however, differences among physicians on reasons to consider termination and their perceived professional responsibility to the fetus or mother. Further investigation on a larger geographic scale may reveal additional insights on variations in physician beliefs and whether such beliefs affect variability in counseling practices.
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Affiliation(s)
- Anna M Martens
- Pediatrics, Massachusetts General for Children, Boston, MA, USA
| | - Chelsey C Lim
- Pediatrics, Massachusetts General for Children, Boston, MA, USA
| | - Michael Kelly
- Internal Medicine and Pediatrics, Massachusetts General for Children, Boston, MA, USA
| | - Caitlin S Haxel
- Pediatric Cardiology, The University of Vermont Children's Hospital, Burlington, VT, USA
| | - Christina Ronai
- Pediatric Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Joanne S Chiu
- Pediatric Cardiology, Massachusetts General Hospital for Children, Boston, MA, USA.
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