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Catapano F, Ramacieri G, Sperti G, Corvaglia LT, Locatelli C. Evaluation of a perinatal palliative care program by SWOT analysis. Pediatr Res 2024:10.1038/s41390-024-03366-2. [PMID: 39266630 DOI: 10.1038/s41390-024-03366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Perinatal Palliative Care (PPC) is individualized medical-nursing care aimed at improving the quality of life of newborns with life-limiting conditions and to support their families. This study draws on the analysis of the experience gained over ten years by a service of PPC called the "Percorso Giacomo" (PG). METHODS We employed a SWOT analysis to identify the strengths, weaknesses, opportunities, and threats of the PG through a systematic retrospective review of 48 cases followed by the program over the course of 10 years, 21 unsolicited parents' narrative and 27 experts' point of view. RESULTS Main strengths of the program were communication and parents' involvement in shared decision-making. Main weaknesses included lack of knowledge of the presence and the role of the PG and lack of resources. For opportunities, the PG proved to be an innovative choice for pregnancies with a fetal life-limiting diagnosis, however threats were identified such as lack of knowledge of PPC and delayed referrals. CONCLUSION The analysis by SWOT method of the 10-year experience of the PG allowed the identification of limitations and areas of improvement, however demonstrated that the PG provided beneficial services to women faced with fetal life-limiting diagnoses. IMPACT Perinatal Palliative Care (PPC) practice and literature on this subject is still limited. This study offers features of the 10-year experience of the Percorso Giacomo (PG), a service of PPC, through a SWOT analysis. By identifying strengths, weaknesses, opportunities and threats of the PG, the study shows limitations and areas of improvement but also benefits of a PPC service to women with fetal diagnosis of life-limiting condition and may allow replication in other institutions.
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Affiliation(s)
- Francesca Catapano
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Ramacieri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- School of Specialization in Child Neuropsychiatric, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Giacomo Sperti
- Perinatal comfort care and assistance to the newborn with congenital malformations Unit, Department of Neonatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Tommaso Corvaglia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Neonatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Locatelli
- Perinatal comfort care and assistance to the newborn with congenital malformations Unit, Department of Neonatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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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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Kim SY, Shin J, Oh MY, Youn YA. Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two Time Periods. Indian J Pediatr 2024:10.1007/s12098-024-05164-4. [PMID: 38836963 DOI: 10.1007/s12098-024-05164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To investigate the impact of proactive perinatal care on periviable preterm infants before and after its implementation. METHODS This retrospective cohort study was conducted over a period of 10 y, from 2013 to 2019, referred to as Phase I, and from 2020 to 2022, referred to as Phase II. A total of 162 eligible infants born between 220/7 and 256/7 wk of gestation were included in this analysis. RESULTS A total of 125 infants were born in phase I, and 37 infants in phase II received proactive care with minimal handling. The mortality decreased from 54.4% to 24.3% (P = 0.001). The composite outcomes of severe brain injury or death, sepsis or death and necrotizing enterocolitis or death were also improved with proactive care. Gestational age [adjusted odds ratio (aOR) 0.900; 95% confidence interval (CI), 0.836-0.970], air leak syndrome (aOR 4.958; 95% CI, 1.681-14.624), massive pulmonary hemorrhage (aOR 4.944; 95% CI, 2.055-11.893), and birth in phase II (aOR 0.324; 95% CI, 0.115-0.912) were independently associated with mortality. CONCLUSIONS The implementation of proactive care with minimal handling resulted in an increased survival rate and a reduction in the combined morbidities between the two time periods. The provision of proactive perinatal care with minimal handling is crucial for improving both the survival rates and clinical outcomes of these vulnerable infants.
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Affiliation(s)
- Sae Yun Kim
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jeongmin Shin
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Moon Yeon Oh
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Ah Youn
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Santiago-Warner S. Social work practice in perinatal palliative care: an overview. SOCIAL WORK IN HEALTH CARE 2024; 63:248-262. [PMID: 38357813 DOI: 10.1080/00981389.2024.2316697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/30/2023] [Indexed: 02/16/2024]
Abstract
Social workers in Perinatal Palliative Care (PPC) play an essential role in caring for birthing people carrying a baby with a life-limiting condition and their families. Perinatal palliative care is consistent with social work values concerning fostering quality of life and promoting social justice and access to care. Social workers play a multidimensional role in providing a holistic approach to caring for the birthing person, baby, and family. Although social workers may be part of an interdisciplinary care team, their role is not defined solely by the goals of the greater team, nor has it been discussed in depth in the perinatal palliative care literature. The purpose of this paper is to describe the knowledge, values, and skills essential to the role of the social worker in a hospital-based perinatal palliative care team. A case study will be used to illustrate the relevant practices, and implications are outlined.
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McCarthy FT, Kenis A, Parravicini E. Perinatal palliative care: focus on comfort. Front Pediatr 2023; 11:1258285. [PMID: 37822320 PMCID: PMC10562587 DOI: 10.3389/fped.2023.1258285] [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: 07/13/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Providing comfort while a patient is living with a life-limiting condition or at end of life is the hallmark of palliative care regardless of the patient's age. In perinatal palliative care, the patient is unable to speak for themselves. In this manuscript we will present guidelines garnered from the 15-year experience of the Neonatal Comfort Care Program at Columbia University Irving Medical Center, and how they provide care for families along the perinatal journey. We will describe essential tools and strategies necessary to consider in assessing and providing comfort to infants facing a life-limiting diagnosis in utero, born at the cusp of viability or critically ill where the burden of care may outweigh the benefit.
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Affiliation(s)
| | | | - E. Parravicini
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, United States
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Abayneh M, Rent S, Ubuane PO, Carter BS, Deribessa SJ, Kassa BB, Tekleab AM, Kukora SK. Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development. Front Pediatr 2023; 11:1217209. [PMID: 37435165 PMCID: PMC10331424 DOI: 10.3389/fped.2023.1217209] [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: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.
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Affiliation(s)
- Mahlet Abayneh
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sharla Rent
- Duke Department of Pediatrics, Duke School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Durham, NC, United States
| | - Peter Odion Ubuane
- Department of Pediatrics, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
| | - Brian S. Carter
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Solomie Jebessa Deribessa
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Betelehem B. Kassa
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Stephanie K. Kukora
- Division of Neonatology and Bioethics Center, Children’s Mercy Hospital, Kansas City, MO, United States
- Department of Pediatrics and Department of Medical Humanities and Bioethics, Universityof Missouri-Kansas City School of Medicine, Kansas City, MO, United States
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Santiago-Warner S. The Integration of the Resolved Through Sharing Perinatal Bereavement Follow-up Model with Latinx Cultural Values: A Case Illustration. CLINICAL SOCIAL WORK JOURNAL 2023:1-11. [PMID: 37360753 PMCID: PMC10155130 DOI: 10.1007/s10615-023-00873-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
The Resolved Through Sharing (RTS) Perinatal bereavement model is an approach used for working with birthing people and their families who have experienced a perinatal loss. RTS is designed to help families cope with their grief and integrate the loss in their lives, meet the needs of the families during the initial crisis, and offer comprehensive care to each member of the family affected by the loss. This paper utilizes a case illustration to describe a year-long bereavement follow-up of an undocumented underinsured Latina woman who suffered a stillbirth during the beginning of the COVID-19 pandemic and the hostile anti-immigrant policy during the Trump presidency. The case illustration is based on a composite case of several Latina women who had pregnancy losses with similar outcomes, demonstrating how a perinatal palliative care (PPC) social worker provided ongoing bereavement support to a patient who experienced a stillbirth. The case illustrates how the PPC social worker utilized the RTS model, incorporated the patient’s cultural values, and acknowledged systemic challenges which resulted in the patient receiving comprehensive, holistic support that aided her emotional and spiritual recovery from her stillbirth. The author ends with a call to action for providers in the field of perinatal palliative care to incorporate practices that allow for greater access and equity for all birthing people.
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Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana. J Pediatr 2023; 254:33-38.e3. [PMID: 36244445 DOI: 10.1016/j.jpeds.2022.10.011] [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: 05/05/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. STUDY DESIGN Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. RESULTS Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. CONCLUSIONS Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.
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Dombrecht L, Chambaere K, Beernaert K, Roets E, De Vilder De Keyser M, De Smet G, Roelens K, Cools F. Components of Perinatal Palliative Care: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:482. [PMID: 36980040 PMCID: PMC10047326 DOI: 10.3390/children10030482] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
When a severe diagnosis is made before or after birth, perinatal palliative care (PPC) can be provided to support the infant, parents and involved healthcare providers. An integrative and systematic overview of effectiveness and working components of existing PPC programs was needed. An integrative search was conducted in MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo and Web of Science. Study designs examining the effect of PPC compared to regular care, and (empirical) articles describing the components of care included in existing PPC initiatives were included. Three independent authors reviewed titles, abstracts and full texts against eligibility criteria. PRISMA guidelines were followed; 21.893 records were identified; 69 publications met inclusion criteria. Twelve publications (17.4%) discussed the effect of a PPC program. Other publications concerned the description of PPC programs, most often by means of a program description (22/69; 31.9%), guidelines (14/769; 20.3%) or case study (10/69; 14.5%). Outcome measures envisioned four main target categories: care coordination, parents and family members, care for the fetus/neonate and healthcare providers. No trials exist to date. Analysis of working components revealed components related to changes directed to the policy of the hospital wards and components involving actual care being provided within the PPC program, directed to the fetus or infant, the family, involved healthcare providers or external actors. PPC is a growing research field where evidence consists mainly of descriptive studies and guidelines. The extensive list of possible PPC components can serve as a checklist for developing future initiatives worldwide. PPC includes several important actors: the fetus/infant and their family and included healthcare providers on both maternity and neonatal wards. This leads to a large variety of possible care components. However, while some studies show proof of concept, an evidence base to determine which components are actually effective is lacking.
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Affiliation(s)
- Laure Dombrecht
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, 1090 Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, 1090 Brussels, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, 1090 Brussels, Belgium
| | - Ellen Roets
- Department of Obstetrics, Women’s Clinic, University Hospital Ghent, 9000 Ghent, Belgium
| | | | - Gaëlle De Smet
- Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Kristien Roelens
- Department of Obstetrics, Women’s Clinic, University Hospital Ghent, 9000 Ghent, Belgium
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Buskmiller C, Ho S, Chen M, Gants S, Crowe E, Lopez S. Patient-centered perinatal palliative care: family birth plans, outcomes, and resource utilization in a diverse cohort. Am J Obstet Gynecol MFM 2022; 4:100725. [PMID: 35995365 DOI: 10.1016/j.ajogmf.2022.100725] [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: 05/20/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Perinatal palliative care is an emerging concept in fetal medicine that offers quality-of-life options and anticipatory grief management for families of fetuses with complex conditions. Few perinatal palliative care outcomes are detailed in peer-reviewed literature. OBJECTIVE This study aimed to describe outcomes of perinatal palliative care at the Fetal Center of the University of Texas Health Science Center at Houston and Women's Center at Children's Memorial Hermann Hospital. STUDY DESIGN This was a retrospective cohort of families receiving perinatal palliative care for life-limiting fetal diagnosis, such as trisomy 13 or 18 and some major structural anomalies between 2016 and 2020. The primary outcome was whether delivery events matched families' birth plans, including fetal/neonatal clinical course matching expectations described by consultant notes. Secondary outcomes included maternal safety outcomes, use of perinatal interventions, delivery outcomes, and resource utilization outcomes. RESULTS Of 187 perinatal palliative care consults, delivery events matched families' plans and clinicians' expectations in 89% of cases (165/185); 39% (73/187) of families requested some perinatal interventions, 64% of whom planned postnatal comfort care even while choosing antenatal interventions. Demographics and median income were similar between families who chose some interventions and those who chose comfort care. Patients choosing any interventions had more mismatches between their plans and delivery events (19% vs 2%; P<.001), were more likely to change their plans (24% vs 6%; P=.001), and unsurprisingly used more healthcare resources. They were also more likely to have intraamniotic infection or postpartum hemorrhage (9% vs 22%; P=.02), but this was associated with mode of delivery and not choice of interventions. CONCLUSION Most families' perinatal experiences matched birth plans and expectations in this perinatal palliative care program. Families who desired interventions used more healthcare resources, but often did so with plans for postnatal comfort care, demonstrating insight into neonatal prognosis but achieving value-consistent goals, such as meeting a live neonate. Perinatal palliative care was safe for maternal patients and equitable across racial, ethnic, and income groups. Perinatal palliative care and some perinatal interventions are options for care of the whole family in complex fetal medicine cases.
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Affiliation(s)
- Cara Buskmiller
- Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Buskmiller and Ho, Ms Chen, Dr Gants, and Ms Crowe).
| | - Stephanie Ho
- Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Buskmiller and Ho, Ms Chen, Dr Gants, and Ms Crowe)
| | - Michelle Chen
- Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Buskmiller and Ho, Ms Chen, Dr Gants, and Ms Crowe)
| | - Shavonia Gants
- Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Buskmiller and Ho, Ms Chen, Dr Gants, and Ms Crowe)
| | - Ellen Crowe
- Departments of Obstetrics, Gynecology and Reproductive Sciences (Drs Buskmiller and Ho, Ms Chen, Dr Gants, and Ms Crowe)
| | - Suzanne Lopez
- Pediatrics (Dr Lopez), The University of Texas Health Science Center at Houston, Houston, TX
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Lord S, Williams R, Pollard L, Ives-Baine L, Wilson C, Goodman K, Rapoport A. Reimagining Perinatal Palliative Care: A Broader Role for Support in the Face of Uncertainty. J Palliat Care 2022; 37:476-479. [PMID: 35657323 PMCID: PMC9465549 DOI: 10.1177/08258597221098496] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perinatal medicine is confronted by a growing number of complex fetal conditions that can be diagnosed prenatally. The evolution of potentially life-prolonging interventions for the baby before and after birth contributes to prognostic uncertainty. For clinicians who counsel families in these circumstances, determining which ones might benefit from early palliative care referral can be challenging. We assert that all women carrying a fetus diagnosed with a life-threatening condition for which comfort-focused care at birth is one ethically reasonable option ought to be offered palliative care support prenatally, regardless of the chosen plan of care. Early palliative care support can contribute to informed decision making, enhance psychological and grief support, and provide opportunities for care planning that includes ways to respect and honor the life of the fetus or baby, however long it may be.
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Affiliation(s)
- Sarah Lord
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Rebecca Williams
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | - Lindsay Pollard
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Lori Ives-Baine
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | | | - Kira Goodman
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada
| | - Adam Rapoport
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Emily's House Children's Hospice, Toronto, Canada
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Benini F, Papadatou D, Bernadá M, Craig F, De Zen L, Downing J, Drake R, Friedrichsdorf S, Garros D, Giacomelli L, Lacerda A, Lazzarin P, Marceglia S, Marston J, Muckaden MA, Papa S, Parravicini E, Pellegatta F, Wolfe J. International Standards for Pediatric Palliative Care: From IMPaCCT to GO-PPaCS. J Pain Symptom Manage 2022; 63:e529-e543. [PMID: 35031506 DOI: 10.1016/j.jpainsymman.2021.12.031] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Since the publication of the IMPaCCT project in 2007, much effort has been made to develop new approaches to pediatric palliative care (PPC). Fifteen years later, it is time to redefine the standards in PPC. OBJECTIVES An international group of experts in PPC has revised the standards in PPC through the GO-PPaCS project (Global Overview - PPC Standards). The goal was to update the PPC standards considering the specificity of different settings, resources, and emerging challenges. The present document is intended to reach all people directly or indirectly involved in PPC. METHODS A literature review in MEDLINE was conducted to expand on the fundamental points and current standards on PPC and to cover an international setting. The literature search (updated on the 15th of April 2021) was carried out using different combinations of keywords and focusing on papers published in English over the past 5 years (2016-2020), but older articles were considered when relevant. The consensus on the fundamental points, standards of care and paper contents was reached by open discussion. RESULTS Fundamental points were defined regarding the definition of PPC, eligibility criteria and the magnitude of the need for PPC, while standards were redefined for the following six areas: 1) clinical, developmental, psychological, social, ethical and spiritual needs; 2) end-of-life care; 3) care models and settings of care; 4) PPC in humanitarian emergencies; 5) care tools; and 6) education and training for healthcare providers. CONCLUSION The present document, developed with the contribution of an international group of experts from different countries, experiences and models of care, provides fundamental points and standards for a wider implementation of PPC worldwide.
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Affiliation(s)
- Franca Benini
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Danai Papadatou
- Professor of Clinical Psychology, Department of Mental Health and Behavioral Studies, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Mercedes Bernadá
- Associated Professor of Pediatrics, School of Medicine, Universidad de la República, Pereira Rossell Hospital Center, Pediatric Palliative Care Team Director, Montevideo, Uruguay
| | - Finella Craig
- Consultant in Paediatric Palliative Medicine at the Louis Dundas Centre, Great Ormond Street Hospital for Children, London, UK
| | - Lucia De Zen
- Pediatric Palliative Care and Pain Service, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Julia Downing
- International Children's Palliative Care Network (ICPCN), Uganda/UK
| | - Ross Drake
- Pediatric Palliative Care and Pain Services, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Stefan Friedrichsdorf
- Professor in Pediatrics, Medical Director, Center of Pediatric Pain, Palliative and Integrative Medicine at UCSF Benioff Children's Hospitals in Oakland and San Francisco, California, USA
| | - Daniel Garros
- Department of Pediatrics, Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital PICU, Edmonton, Alberta, Canada
| | | | - Ana Lacerda
- Department of Pediatrics, Portuguese Institute of Oncology, Lisbon Centre, Lisbon, Portugal
| | - Pierina Lazzarin
- Paediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Joan Marston
- Sunflower Children's Hospice, Bloemfontein, South Africa
| | | | | | | | | | - Joanne Wolfe
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute and Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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13
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Zhong Y, Black BP, Kain VJ, Song Y. Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China. Front Pediatr 2022; 10:887711. [PMID: 35813382 PMCID: PMC9263274 DOI: 10.3389/fped.2022.887711] [Citation(s) in RCA: 1] [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: 03/01/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China.
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Affiliation(s)
- Yajing Zhong
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Beth Perry Black
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Victoria J Kain
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Yang Song
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Wool C, Parravicini E. Implementation of Quality Indicators of Perinatal/Neonatal Palliative Care One-Year Following Formal Training. Front Pediatr 2021; 9:752971. [PMID: 34926343 PMCID: PMC8672437 DOI: 10.3389/fped.2021.752971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to measure implementation of quality indicators (QIs) of Perinatal/Neonatal Palliative Care (PNPC) as reported by participants following a one-year training course. Study Design: A cross-sectional survey mixed-method design was used to obtain data from an interdisciplinary team of professionals one year after attending a PNPC training course. A questionnaire with 32 QIs queried participants about self-reported implementation of PNPC and that of their colleagues. Descriptive and frequency data were analyzed to measure the implementation of PNPC QIs. Qualitative data were examined using content analysis. Results: Response rate was 34 of 76 (44.7%). Half of the QIs are implemented in clinical settings by course attendees more than 90% of the time, and 15 QIs are implemented between 70 and 89.9%. Colleagues within the same healthcare system applied palliative care practices less frequently than those who attended the training course. When asked if quality indicators were "always" implemented by colleagues, the average difference in scores was 36% lower. Qualitative analyses resulted in three themes that addressed changes in clinical practice, and four themes that summarized barriers in practice. Conclusion: There is high frequency of implementation of QIs by professionals who attended an evidence based PNPC training course. PNPC is implemented by the colleagues of attendees, but with less frequency. Attending evidence-based education increases clinicians' opportunities to translate quality PNPC care into clinical settings.
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Affiliation(s)
- Charlotte Wool
- Department of Nursing, College of Nursing and Health Professions, York College of Pennsylvania, 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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15
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Clinical Study of Influence of Continuous Nursing Intervention Combined with Comfort Nursing Intervention under Medical-Nursing Combination on Self-Care Ability and Satisfaction of Elderly Patients with Chronic Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1464707. [PMID: 34691203 PMCID: PMC8536435 DOI: 10.1155/2021/1464707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
Objective With the constant development of medical technology, the medical-nursing combination mode targeted at elderly chronic diseases has been proposed, and based on this, the study on the nursing mode of elderly chronic diseases under the background of medical-nursing combination was conducted. Methods Total of 100 elderly patients with chronic diseases who were admitted to our hospital from April 2019 to April 2020 were selected and divided into a control group and an experimental group by lot drawing, with 50 patients in each group. Continuous nursing was conducted to patients in the control group, and continuous nursing combined with comfort nursing was performed to patients in the experimental group, so as to compare their nursing effective rate, satisfaction with nursing, self-care ability at 6 months after nursing, quality of life (QLI) scores, and blood glucose, pressure, and lipid levels at various periods. Results Compared with the control group, the experimental group obtained significantly improved nursing effective rate, satisfaction with nursing, Exercise of Self-Care Agency (ESCA) scale scores, QLI scores, and lower blood glucose, pressure, and lipid levels at various periods 6 months after nursing, with statistical significance (P all < 0.05). Conclusion Under the context of medical-nursing combination, the continuous nursing intervention combined with comfort nursing intervention is conductive to promote the self-care ability and nursing effect of elderly patients with chronic diseases and obviously improve their quality of life and psychological state.
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