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Wilpers AB, Francis K, Powne AB, Somers L, Ren Y, Kohari K, Lorch SA. Differences in Person-Centered Care in Fetal Care Centers: Results from the U.S. Pilot Study of the PCC-FCC Scale. J Pers Med 2024; 14:772. [PMID: 39064026 PMCID: PMC11278169 DOI: 10.3390/jpm14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE We report findings from a U.S. mixed-methods pilot study of the Person-Centered Care in Fetal Care Centers (PCC-FCC) Scale. METHODS Participants, who received care at a U.S. Fetal Care Center (FCC) between 2017 and 2021, completed an online questionnaire providing sociodemographic details, specifics about the care received, qualitative experiences, and scores from the PCC-FCC Scale. RESULTS Participants' (n = 247) PCC-FCC scores and qualitative feedback indicate high perceived person-centered care (PCC), particularly in areas of care coordination, respectful care, and patient education. However, 8% scored below the midpoint, and 38% of comments were negative, especially regarding expectation setting, preparation for post-intervention maternal health, and psychosocial support. Public insurance was associated with higher total PCC-FCC (p = 0.03) and Factor 2 scores (p = 0.02) compared to those with private insurance. The qualitative themes trust, clarity, comprehensive care, compassion, and belonging further elucidate the concept of PCC in FCCs. CONCLUSION The PCC-FCC Scale pilot study revealed strong overall PCC in FCCs, yet variability in patient experiences suggests areas needing improvement, including expectation setting, preparation for post-intervention maternal health, and psychosocial support. Future research must prioritize diverse samples and continued mixed methodologies to better understand the role of insurance and identify other potential disparities, ensuring comprehensive representation of the FCC patient population.
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Affiliation(s)
- Abigail B. Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- St. Louis Fetal Care Institute, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO 63104, USA
| | - Katie Francis
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- St. Louis Fetal Care Institute, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO 63104, USA
| | - Amy B. Powne
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- UC Davis Fetal Care and Treatment Center, UC Davis Health, Sacramento, CA 95817, USA
| | | | - Yunyi Ren
- Department of Public Health Sciences, School of Medicine, University of California-Davis, Sacramento, CA 95616, USA
| | - Katherine Kohari
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Fetal Care Center, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Scott A. Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Wilpers AB, Eichhorn B, Batten J, Francis K, Powne AB, Jumale S, Hansen K, Kohari K, Lorch SA. The Role of Social Determinants in Diagnosis Timing for Fetal Care Center-Eligible Conditions: A Scoping Review. Diagnostics (Basel) 2024; 14:1503. [PMID: 39061640 PMCID: PMC11276164 DOI: 10.3390/diagnostics14141503] [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: 06/17/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Timely identification of fetal conditions enables comprehensive evaluation, counseling, postnatal planning, and prenatal treatments. This study assessed the existing evidence on how social determinants of health (SDOH) influence diagnosis timing of fetal conditions appropriate for care in fetal care centers (FCCs). Eligible studies were conducted in the U.S. and published in English after 1999. We employed the Healthy People 2020 SDOH framework to categorize and analyze data from 16 studies, where 86% focused solely on congenital heart disease (CHD). Studies primarily focused on individual-level SDOH, with only 36% addressing structural-level factors. A total of 31 distinct indicators of SDOH were identified, with 68% being unique to individual studies. Indicators often varied in definition and specificity. Three studies covered all five SDOH categories in the Healthy People 2020 Framework. Studies revealed varying and often conflicting associations with SDOH indicators, with race and ethnicity being the most explored (100%), followed by socioeconomic status (69%), maternal age (57%), residence (43%), and structural factors (29%). Our findings highlight the need for more comprehensive research, including conditions beyond CHD, and the establishment of consensus on indicators of SDOH. Such efforts are necessary to gain a deeper understanding of the underlying factors driving disparities in fetal diagnosis and treatment.
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Affiliation(s)
- Abigail B. Wilpers
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
| | - Barbara Eichhorn
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
- Fetal Diagnosis and Treatment Centers, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, USA
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06520, USA;
| | - Katie Francis
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
- St. Louis Fetal Care Institute, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO 63104, USA
| | - Amy B. Powne
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
- UC Davis Fetal Care and Treatment Center, UC Davis Health, Sacramento, CA 95817, USA
| | - Shukri Jumale
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN 55404, USA
| | - Kara Hansen
- Fetal Therapy Nurse Network, Chicago, IL 60611, USA; (K.F.); (A.B.P.); (S.J.); (K.H.)
- Fetal Health Center, Children’s Mercy, Kansas City, MO 64108, USA
| | - Katherine Kohari
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA;
- Fetal Care Center, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Scott A. Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kotlier JL, Fathi A, Kumaran P, Mayfield CK, Orringer M, Liu JN, Petrigliano FA. Randomized controlled trials in the shoulder arthroplasty literature rarely include key demographic and socioeconomic patient data. J Shoulder Elbow Surg 2024; 33:e296-e301. [PMID: 38373484 DOI: 10.1016/j.jse.2023.12.025] [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: 09/25/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND It is well known that socioeconomic and demographic variables can greatly affect health outcomes. Previous studies across medical and surgical subspecialties have demonstrated that these variables are frequently under-reported in randomized controlled trials (RCTs). No such study currently exists that examines rates of reporting of sociodemographic variables in shoulder arthroplasty RCTs. This study aims to present these rates and explore the impact of failing to report socioeconomic variables in shoulder arthroplasty RCTs. METHODS The PubMed database was queried for the term shoulder arthroplasty. Sixty-five RCTs from the past 10 years were identified for inclusion from 5 high-impact orthopedic surgery journals. Each RCT was analyzed for patient age and sex or gender as well as the following sociodemographic variables: race, ethnicity, insurance status, income, work status, and education. It was also noted whether each of the above variable was mentioned in the results section of the article. Data were presented in a descriptive fashion as well as analyzed using χ2 and Fisher exact tests where appropriate. RESULTS From 2014 to 2023, the 65 shoulder arthroplasty RCTs published reported age in 40 of 65 (61.5%) in their results sections and 61 of 65 (93.8%) in any section. Sex or gender was reported in 27 of 65 (41.5%) in their results sections and 61 of 65 (93.8%) in any section. No articles included any sociodemographic variables in the results section. Reporting rates for sociodemographic variables in any section were as follows: race, 6 of 65 (9.2%); ethnicity, 5 of 65 (7.7%); work status, 4 of 65 (6.2%); and insurance status, 1 of 65 (1.5%). No studies included income or education of the enrolled patients. There was no difference in reporting sociodemographic variables by journal (P = .45) or by year of publication (P = .57). However, no study prior to 2020 included any sociodemographic variable (0 of 27, 0%), whereas from 2020 onward 6 studies included at least 1 (6 of 38, 15.8%). Sociodemographic variables were reported significantly less frequently than age and sex or gender (P = .001). DISCUSSION Our study found sociodemographic variables are rarely reported in shoulder arthroplasty RCTs, whereas age and sex or gender are reported with great frequency. In order to understand the results of shoulder arthroplasty RCTs, apply their findings to the care of our patients, and address health disparities, we must ensure these studies include patient sociodemographic data.
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Affiliation(s)
| | - Amir Fathi
- USC Keck School of Medicine, Los Angeles, CA, USA
| | | | | | | | - Joseph N Liu
- USC Keck School of Medicine, Los Angeles, CA, USA
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Claes D, Markham KB, Cortezzo DE. An Ethical Analysis of Therapy for Severe Congenital Kidney and Urinary Tract Anomalies. Pediatrics 2024; 153:e2023064720. [PMID: 38784992 DOI: 10.1542/peds.2023-064720] [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] [Received: 10/18/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024] Open
Abstract
Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed at restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path.
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Affiliation(s)
- Donna Claes
- Divisions of Nephrology
- Departments of Pediatrics
| | - Kara B Markham
- Cincinnati Children's Fetal Care Center
- Obstetrics and Gynecology and Division of Maternal Fetal Medicine
| | - DonnaMaria E Cortezzo
- Cincinnati Children's Fetal Care Center
- Neonatal and Pulmonary Biology
- Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Departments of Pediatrics
- Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Divisions of Neonatology
- Pain and Palliative Care
- Fetal Care Program, Connecticut Children's Medical Center, Hartford, Connecticut
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
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Goldblatt Hyatt E, Wilpers A, Bahtiyar MO, Hu Y, Leon-Martinez D, Chervenak FA, McCoyd JLM. "I don't have a telephone to the fetus": Clinicians' conceptions of fetal patienthood in maternal-fetal surgery counseling. Soc Sci Med 2024; 342:116525. [PMID: 38199011 DOI: 10.1016/j.socscimed.2023.116525] [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: 07/04/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024]
Abstract
RATIONALE Maternal fetal surgery (MFS) has developed rapidly since the 1960s and centers for fetal diagnosis and therapy (CFDT) have proliferated. As a result, CFDT clinicians have intervened with fetuses through pregnant bodies for decades, yet the patienthood status of the fetus and its implications for the pregnant person's autonomy have been relatively unexamined. OBJECTIVE Our overall research aims were threefold: (1) to explore how clinicians train for and provide counseling for MFS; (2) to examine how clinicians assess fetal patienthood and its implications; and (3) to understand clinicians' professed needs and their recommendations for education and training for the provision of MFS counseling. This focuses on aim two. METHOD In this qualitative study, conducted using in-depth interviews, we examined how 20 clinicians from 17 different sites understood fetal patienthood, how that affected their counseling of pregnant patients, and whether they drew on extant ethical frameworks for guidelines. RESULTS We identified three major themes: 1) Clinicians entered fetal surgery consultations with assumptions about fetal patienthood (frequently informed by beliefs about fetal viability, maternal attachment, and disciplinary perspectives); 2) they consciously assessed their pregnant patients' connections to their fetus to inform or re-calibrate their own understandings of fetal patienthood; and 3) they used a threshold -based conceptualization whereby the fetus achieved patienthood after crossing a symbolic boundary, often related to the clinician's ability to intervene. CONCLUSIONS Few clinicians invoked an extant ethical framework to determine fetal patienthood; most asserted that they did not view directive counseling toward MFS as appropriate, instead working diligently to protect pregnant patients' autonomy and rights to self-determination.
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Affiliation(s)
- E Goldblatt Hyatt
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
| | - Abigail Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 9 Philadelphia, PA, USA; Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mert Ozan Bahtiyar
- Fetal Care Center, Yale New Haven Hospital, New Haven, CT, USA; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, And Reproductive 15 Sciences, New Haven, CT, USA
| | - Yunzhe Hu
- Columbia University, New York, NY, USA
| | | | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell 20 and Lenox Hill Hospital, Hempstead, NY, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Wilpers A, Goldblatt Hyatt E, Bahtiyar MO, Hu Y, Leon-Martinez D, Chervenak FA, McCoyd JLM. "We All Want to Be Able to Tell You Something Hopeful": Clinicians' Experiences Providing Maternal-Fetal Surgery Counseling. Fetal Diagn Ther 2023; 50:353-367. [PMID: 37315537 DOI: 10.1159/000531535] [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] [Received: 12/28/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Prenatal counseling about maternal-fetal surgery can be traumatic and confusing for pregnant people. It can also be technically and emotionally complex for clinicians. As maternal-fetal surgery rapidly advances and becomes more common, more evidence is needed to inform counseling practices. The objective of this study was to develop a deeper understanding of the methods clinicians currently use to train for and provide counseling, as well as their needs and recommendations for future education and training. METHODS We used interpretive description methods and interviewed interprofessional clinicians who regularly counsel pregnant people about maternal-fetal surgery. RESULTS We conducted 20 interviews with participants from 17 different sites who were maternal-fetal medicine specialists (30%), pediatric surgeons (30%), nurses (15%), social workers (10%), a genetic counselor (5%), a neonatologist (5%), and a pediatric subspecialist (5%). Most were female (70%), non-Hispanic white (90%), and practiced in the Midwest (50%). We identified four overarching themes: (1) contextualizing maternal-fetal surgery counseling; (2) establishing shared understanding; (3) supporting decision-making; and (4) training for maternal-fetal surgery counseling. Within these themes, we identified key practice differences among professions, specialties, institutions, and regions. CONCLUSION Participants are committed to practicing informative and supportive counseling to empower pregnant people to make autonomous decisions about maternal-fetal surgery. Nevertheless, our findings indicate a dearth of evidence-based communication practices and guidance. Participants identified significant systemic limitations affecting pregnant people's decision-making options related to maternal-fetal surgery.
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Affiliation(s)
- Abigail Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, Yale School of Medicine and Yale School of Nursing, New Haven, Connecticut, USA
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Erica Goldblatt Hyatt
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mert Ozan Bahtiyar
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Yunzhe Hu
- Barnard College, New York, New York, USA
| | - Daisy Leon-Martinez
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, Hempstead, New York, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Laguna‐Torres A, Velosa L, Barreto A, Lorch SA, Virudachalam S, Montoya‐Williams D. Overcoming barriers to the recruitment of immigrant Hispanic people in perinatal research. Health Serv Res 2023; 58:543-548. [PMID: 36600513 PMCID: PMC10154151 DOI: 10.1111/1475-6773.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alicia Laguna‐Torres
- Division of NeonatologyChildren's Hospital of Philadelphia, Roberts Building for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Leo Velosa
- Division of NeonatologyChildren's Hospital of Philadelphia, Roberts Building for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | | | - Scott A. Lorch
- Division of NeonatologyChildren's Hospital of Philadelphia, Roberts Building for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Senbagam Virudachalam
- Division of General PediatricsChildren's Hospital of Philadelphia, Roberts Building for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Diana Montoya‐Williams
- Division of NeonatologyChildren's Hospital of Philadelphia, Roberts Building for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
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