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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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Schweiberger K, Harris KW, Kavanaugh-McHugh A, Soudi A, Arnold RM, Merlin JS, Kasparian NA, Chang JC. "I Just Want You to Hear That Term": Characterizing Language Used in Fetal Cardiology Consultations. J Cardiovasc Dev Dis 2023; 10:394. [PMID: 37754823 PMCID: PMC10531623 DOI: 10.3390/jcdd10090394] [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: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
The way clinicians communicate with parents during pregnancy about congenital heart disease (CHD) can significantly influence parental understanding of and psychological response to the diagnosis. A necessary first step to improving communication used in fetal cardiology consultations is to understand and describe the language currently used, which this paper aims to do. Nineteen initial fetal cardiology consultations with parents were audio-recorded, transcribed verbatim, and coded by two independent coders. A codebook was inductively developed and applied to all transcripts. The finalized coding was used to characterize fetal cardiologists' language. We identified four discourse styles employed in fetal cardiology consultations: small talk, medical, plain, and person-centered. Plain language was used to define and emphasize the meaning of medical language. Person-centered language was used to emphasize the baby as a whole person. Each consultation included all four discourse styles, with plain and medical used most frequently. Person-centered was used less frequently and mostly occurred near the end of the encounters; whether this is the ideal balance of discourse styles is unknown. Clinicians also used person-centered language (as opposed to disease-centered language), which is recommended by medical societies. Future studies should investigate the ideal balance of discourse styles and the effects of clinician discourse styles on family outcomes, including parents' decision-making, psychological adjustment, and quality of life.
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Affiliation(s)
- Kelsey Schweiberger
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Kelly W. Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Ann Kavanaugh-McHugh
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Abdesalam Soudi
- Department of Linguistics, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Robert M. Arnold
- Section of Palliative Care and Medical Ethics, Department of General Internal Medicine, Palliative Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (R.M.A.); (J.S.M.)
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics, Department of General Internal Medicine, Palliative Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (R.M.A.); (J.S.M.)
| | - Nadine A. Kasparian
- The Heart Institute, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA;
- Department of Pediatrics, College of Medine, University of Cincinnati, Cincinnati, OH 45267, USA
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital, Cincinnati, OH 45229, USA
| | - Judy C. Chang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
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Butler M, McArthur EC. The Role of Nurses in Fetal Cardiology Programs: An Integrative Review. MCN Am J Matern Child Nurs 2023; 48:151-160. [PMID: 37101328 DOI: 10.1097/nmc.0000000000000910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Fetal cardiology programs are evolving quickly and include multiple interdisciplinary health care professionals whose roles could benefit from clear definition. Nurses provide an essential function in this field; however, descriptions or definitions of nursing practice, education and knowledge requirements, and responsibilities are limited and vary across institutions and disciplines. PURPOSE To conduct an integrative review summarizing the literature to determine the role of nurses in fetal cardiology programs. METHODS We conducted an integrative review as per Whittemore and Knafl's (2005) methodology of current literature to reveal strengths and opportunities in describing nursing practice as fetal cardiology nurses. The search strategy included five electronic databases: CINAHL, Medline, PsycINFO, Web of Science, and Google Scholar. Peer-reviewed English-language articles discussing nursing practices in fetal cardiology published between 2015 and 2022 were selected. Data extraction and analysis were completed on a final sample of 26 articles. RESULTS Four themes were identified on fetal cardiac nursing practice from nursing and medical perspectives: multidisciplinary key team member, psychosocial family support and counselor, coordinator or navigator, and role description. CLINICAL IMPLICATIONS More discussion in the literature is needed to better understand and define fetal cardiac nursing practice. Although most experts agree nurses are an important member of the interdisciplinary fetal cardiology team, their roles and educational requirements are poorly described and defined. Quality metrics and benchmarks are needed to ensure safe and effective fetal cardiology care.
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Gendler Y, Birk E, Tabak N, Koton S. Vigilance in the Decision-Making Process Regarding Termination of Pregnancy Following Prenatal Diagnosis of Congenital Heart Disease-Application of the 'Conflict Decision-Making Model'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159137. [PMID: 35897499 PMCID: PMC9331975 DOI: 10.3390/ijerph19159137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022]
Abstract
The decision-making process regarding termination of pregnancy following prenatal diagnosis of congenital heart disease is a stressful experience for future parents. Janis and Mann’s conflict decision-making model describes seven ideal stages that comprise vigilant information-gathering as an expression of the qualitative decision-making process. In our study, we attempted to determine whether parents who face the decision regarding termination of pregnancy undertake a qualitative decision-making process. Data were collected over 2-year period using structural questionnaires. The sample consisted of two hundred forty participants; sixty-nine (28.75%) declared that their decision was to terminate the pregnancy. A significant difference in the quality of the decision-making score was noted between parents who decided to continue with the pregnancy vs. parents who opted for termination (mean score of 10.15 (5.6) vs. 18.51 (3.9), respectively, p < 0.001). Sixty-two (90%) participants within the termination of pregnancy group went through all seven stages of vigilant decision-making process and utilized additional sources for information and consultation. Parents who decided to continue with the pregnancy made swift decisions, often without considering the negative and positive outcomes; this decision-making pattern is considered non-vigilant and ineffective. Identification of future parents at risk of going through an ineffective decision-making process may help health professionals to determine the best way to provide them with information and support.
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Affiliation(s)
- Yulia Gendler
- Department of Nursing, School of Health Sciences, Ariel University, Ariel 40700, Israel
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
- Correspondence:
| | - Einat Birk
- Pediatric Heart Institute, Schneider Children’s Medical Center of Israel, Petah-Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Nili Tabak
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
| | - Silvia Koton
- Department of Nursing, School of Health Professions, Tel-Aviv University, Tel-Aviv 69978, Israel; (N.T.); (S.K.)
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Whitehead J, Hirsch J, Rosoklija I, Weisman AG, Dungan J, Finlayson C, Chen D, Johnson EK. Prenatal Detection and Evaluation of Differences of Sex Development: A Qualitative Interview Study of Parental Perspectives and Unmet Needs. Prenat Diagn 2022; 42:1332-1342. [PMID: 35670269 PMCID: PMC9545652 DOI: 10.1002/pd.6191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022]
Abstract
Objectives Prenatal diagnoses of differences of sex development (DSD) are increasing due to availability of cell‐free DNA screening (cell‐free DNA screening (cfDNA)). This study explores first‐hand experiences of parents whose children had prenatal findings of DSD. Methods Eligible parents were identified through chart review at a pediatric center and interviewed about their prenatal evaluation, decision making, informational sources, and support systems. Interviews were coded using a combined inductive and deductive thematic analysis. Parents also completed quantitative measures of decisional regret. Results Seventeen parents (13 mothers; 4 fathers) of 13 children (with 7 DSD diagnoses) were recruited. Four children had discordance between sex predicted by cfDNA versus prenatal ultrasound, and 2 had non‐binary appearing (atypical) genitalia on prenatal ultrasound. Of these 6, 3 were not offered additional prenatal testing or counseling. Most parents described tension between obtaining support through disclosure of their child's diagnosis and preserving their child's autonomy/privacy, highlighting the need for mental health support. Conclusion This is the first study to gather qualitative data from parents whose children had prenatal findings of DSD. We identified multiple targets for intervention to improve care for patients with DSD across the lifespan, including improvements in clinician education, pre‐ and post‐test counseling, and patient education materials.
What's already known about this topic? What does this study add?
Prenatal detection of potential differences of sex development (DSD) is increasing as the availability of non‐invasive prenatal screening increases. Algorithms have been developed for the diagnostic evaluation, but little is known about the psychosocial implications of that process. This study focuses on the first‐hand experiences of families whose children had prenatal findings of a potential DSD, to identify existing sources of support and information, and areas for future improvement.
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Affiliation(s)
- J Whitehead
- Division of Endocrinology, Chicago, United States.,Department of Pediatrics, Chicago, United States
| | | | | | | | | | - Courtney Finlayson
- Division of Endocrinology, Chicago, United States.,Department of Pediatrics, Chicago, United States
| | - Diane Chen
- Adolescent & Young Adult Medicine, Chicago, United States.,Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Chicago, United States.,Psychiatry & Behavioral Sciences, Chicago, United States
| | - Emilie K Johnson
- Urology, Chicago, United States.,Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tacy TA, Kasparian NA, Karnik R, Geiger M, Sood E. Opportunities to enhance parental well-being during prenatal counseling for congenital heart disease. Semin Perinatol 2022; 46:151587. [PMID: 35461701 DOI: 10.1016/j.semperi.2022.151587] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prenatal diagnosis of congenital heart disease (CHD) can be a life-altering and traumatic event for expectant parents. Parental anxiety, depression, and traumatic stress are common following a prenatal cardiac diagnosis and if untreated, symptoms often persist long-term. During prenatal counseling, parents must try to manage psychological distress, navigate uncertainty, process complex medical information, and make high-stakes medical decisions for their unborn child and their family. Physicians must deliver the diagnosis, describe the expected perinatal management plan, discuss short and long-term prognoses and introduce elements of uncertainty that may exist for the particular diagnosis. Physican training in these important skills is highly variable and many in our field acknowledge the need for improved guidance on best practices for counseling and supporting parents during pregnancy and early parenthood after prenatal diagnosis, while also sustaining physicians' own emotional well-being. We describe these challenges and the opportunities that exist to improve the current state of prenatal counseling in CHD.
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Affiliation(s)
- Theresa A Tacy
- Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Nadine A Kasparian
- Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, OU, USA
| | - Ruchika Karnik
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Miwa Geiger
- Department of Pediatrics, Division of Pediatric Cardiology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Sood
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Holm KG, Neville AJ, Pierini A, Latos Bielenska A, Jamry-Dziurla A, Cavero-Carbonell C, Garne E, Clemensen J. The Voice of Parents of Children With a Congenital Anomaly - A EUROlinkCAT Study. Front Pediatr 2021; 9:654883. [PMID: 34912754 PMCID: PMC8667600 DOI: 10.3389/fped.2021.654883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
EUROlinkCAT aims to investigate the health and educational outcomes of children with congenital anomalies for the first 10 years of their lives. We also aim to facilitate the development of a more reciprocal relationship between families with children with congenital anomalies, health and social care professionals, and researchers by conducting focus groups. The aim of the focus groups and parent interviews was to investigate parental experiences of having a child with a heart defect requiring surgery, cleft lip, spina bifida or Down Syndrome and to identify their research priorities. In total, seven interviews with 12 parents and eight focus groups with 58 parents and two caregivers were conducted in four European countries. We found that parents request more positive information with a focus on quality of life and what the children can achieve rather than solely on the negative aspects and limitations of the congenital anomaly. Some parents also highlighted discrepancies between the family's need for support and the lack of support received from the local authority. Finally, it was challenging for the parents to address specific research priorities. Future research should therefore focus on the potential of a child with a congenital anomaly.
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Affiliation(s)
- Kristina Garne Holm
- H.C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amanda Julie Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Anna Pierini
- Tuscany Registry of Congenital Defects (RTDC), Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Anna Latos Bielenska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Science, Poznan, Poland
| | - Anna Jamry-Dziurla
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Science, Poznan, Poland
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt-Kolding, Kolding, Denmark
| | - Jane Clemensen
- H.C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Knight Lozano R, May S, Clarkson C, Sarjeant R. Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review. Eur J Cardiovasc Nurs 2020; 20:147-159. [PMID: 33849062 DOI: 10.1177/1474515120951974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/04/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. AIM The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. METHODS Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. RESULTS Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. CONCLUSIONS Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.
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Affiliation(s)
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK
| | - Carl Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
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Gaskin K, Kennedy F. Care of infants, children and adults with congenital heart disease. Nurs Stand 2020; 34:37-42. [PMID: 31468777 DOI: 10.7748/ns.2019.e11405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Abstract
Congenital heart disease refers to an anatomical or physiological defect of the heart that is present at birth. Over the past three decades there have been significant advances in surgical, medical and nursing care for infants and children requiring cardiac surgery for congenital heart disease. This has meant that the number of adults with moderate and complex congenital heart disease now exceeds the number of children with the disease. This article details the background and diagnosis of congenital heart disease. It considers the implications for infants and children with congenital heart disease, as well as their parents, such as screening methods, risk factors, parental stress and psychosocial needs. This article also discusses the care of adults with congenital heart disease, including specialist monitoring and patient education.
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Affiliation(s)
- Kerry Gaskin
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, England, and chairperson of the Congenital Cardiac Nurses Association
| | - Fiona Kennedy
- Barts Health NHS Trust, London, England, and member of the British Adult Congenital Cardiac Nurses Association
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