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Bluebond-Langner M, Wakeling S, Vincent K, Butler A, Brown K, Jowett V. British Congenital Cardiac Association Fetal Cardiology Standards: impact of Patient and Public involvement exercise on the development of clinical standards. Cardiol Young 2023:1-5. [PMID: 38131145 DOI: 10.1017/s1047951123004298] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To examine the impact of a Patient and Public Involvement exercise on the development of British Congenital Cardiac Association Fetal Cardiology Standards 2021. DESIGN Open-ended, semi-structured interviews were undertaken to inform the design of a study to improve the quality of parents' experiences during antenatal and perinatal care of their child with CHD. This Patient and Public Involvement exercise was used to inform the final version of the drafted 'Standards'. SETTING One-on-one interviews with parents who responded to a request on the closed Facebook page of the user group "Little Hearts Matter": "Would you be interested in helping us to design a study about parents' experience on learning that their child had CHD"? PATIENTS Parents of children with single ventricle CHD. RESULTS Twenty-one parents (18 mothers, 3 fathers) participated. Parents responses were reported to have variably reinforced, augmented, and added specificity in the later stages of drafting to six of the seven subsections of Section C Information and Support for Parents including: "At the time of the Scan"; "Counselling following the identification of an abnormality"; "Written information/resources"; "Parent support"; "Communication with other teams and ongoing care"; and "Bereavement support". CONCLUSIONS This Patient and Public Involvement exercise successfully informed the development of Standards after the initial drafting. It contributed to the establishment of face validity of the 'Standards', especially when consistent with what is reported in the literature. Further research is needed to explore approaches to involving and standardising Patient and Public Involvement in the development of clinical standards.
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Affiliation(s)
- Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sara Wakeling
- Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Katherine Vincent
- Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ashleigh Butler
- Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, UK
- School of Nursing and Midwifery, La Trobe University, Melbourne, VC, Australia
| | - Kate Brown
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victoria Jowett
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
- University College London, London, UK
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Pinto NM, Henry KA, Grobman WA, Ness A, Miller S, Ellestad S, Gotteiner N, Tacy T, Wei G, Minich LL, Kinney AY. Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound: A National United States Survey. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1143-1153. [PMID: 31875341 PMCID: PMC7357993 DOI: 10.1002/jum.15199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images. METHODS Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level. RESULTS Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04). CONCLUSIONS Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.
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Affiliation(s)
- Nelangi M Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amen Ness
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Stephen Miller
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nina Gotteiner
- Division of Pediatric Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Theresa Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Guo Wei
- Division of Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - L LuAnn Minich
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, and Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
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Pinto NM, Henry KA, Wei G, Sheng X, Green T, Puchalski MD, Byrne JLB, Kinney AY. Barriers to Sonographer Screening for Fetal Heart Defects: A U.S. National Survey. Fetal Diagn Ther 2019; 47:188-197. [PMID: 31416072 DOI: 10.1159/000501430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We surveyed obstetric sonographers, who are at the forefront of the screening process to determine how barriers to prenatal cardiac screening impacted screening abilities. METHODS We performed a cross-sectional national survey of obstetric sonographers in the United States using a sampling frame from American Registry of Diagnostic Medical Sonography mailing lists. The web survey measured the ability to obtain and interpret fetal heart images. Several cognitive, sociodemographic, and system-level factors were measured, including intention to perform cardiac imaging. Regression and mediation analyses determined factors associated with intention to perform and ability to obtain and interpret cardiac images. Subgroup analyses of sonographers in tertiary versus nontertiary centers were also performed. RESULTS Survey response rate either due to noncontact or nonresponse was 40%. Of 480 eligible sonographers, ~30% practiced in tertiary settings. Sonographers had lower intention to perform outflow views compared to 4 chambers. Higher self-efficacy and professional expectations predicted higher odds of intention to perform outflow views (OR 2.8, 95% CI 1.9-4.2 and 1.9, 95% CI 1.1-3.0, respectively). Overall accuracy of image interpretation was 65% (±14%). For the overall cohort and nontertiary subgroup, higher intention to perform outflows was associated with increased accuracy in overall image interpretation. For the tertiary subgroup, self-efficacy and feedback were strongly associated with accuracy. CONCLUSIONS We identified several modifiable (some heretofore unrecognized) targets to improve prenatal cardiac screening. Priorities identified by sonographers that are associated with screening success should guide future interventions.
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Affiliation(s)
- Nelangi M Pinto
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA,
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
| | - Guo Wei
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Xiaoming Sheng
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Tom Green
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Michael D Puchalski
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Janice L B Byrne
- Department of Internal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Anita Y Kinney
- School of Public Health and Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
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