Impact Of Early Palliative Care Intervention On Maternal Stress In Mothers Of Infants Prenatally Diagnosed With Single Ventricle Heart Disease: A Randomized Clinical Trial.
Title
Impact Of Early Palliative Care Intervention On Maternal Stress In Mothers Of Infants Prenatally Diagnosed With Single Ventricle Heart Disease: A Randomized Clinical Trial.
Creator
Hancock H; Pituch K; Uzark K; Bhat P; Fifer C; Silveira M
Identifier
doi:10.1016/S0735-1097(16)30921-4
Publisher
Journal Of The American College Of Cardiology
Date
2016
Subject
Mothers; Communication; Palliative Care; Families & Family Life; Anxieties; Cardiovascular Disease
Description
Background: Children with single ventricle (SV) cardiac defects requiring staged palliation have a high risk of mortality and receive
invasive and complex care, resulting in significant maternal stress. In other complex, life-limiting illnesses among children, pediatric
palliative care (PPC) may mitigate maternal distress. We hypothesized early PPC in the SV population may have the same beneficial effect
upon mothers.
Methods: In this pilot trial of early PPC, mothers of infants with a prenatal diagnosis of SV completed 4 questionnaires measuring anxiety,
depression, coping, and quality of life/family functioning at a prenatal visit (not at initial diagnosis) and again at neonatal discharge. Infants
were randomized to receive early PPC (defined as initial consultation prior to surgery consisting of structured evaluation, psychosocial/
spiritual support, and communication between mothers and care providers) or usual care.
Results: Among 56 eligible subjects, forty mothers enrolled and completed baseline surveys; 38 neonates randomized (18 early PPC, 20
usual care) and 34 postnatal surveys were completed (3 neonates died, 1 mother declined). Baseline Beck Depression Index II and StateTrait
Anxiety Index (STAI) scores exceeded those of a normal pregnant sample (mean 13.76 ± SD 8.46 vs. 7.0 ± 5.0, and 46.34 ± 12.59
vs. 29.8 ± 6.35, respectively; both P=0.0001), but there were no significant differences between study groups. There was a significant
decrease in prenatal to postnatal STAI scores in the early PPC group (-7.6 vs. 0.3 in usual care, P=0.02). Significantly higher postnatal
Brief Cope Inventory scores for positive reframing, an adaptive response, were noted in the early PPC group (P=0.03). The early PPC
group had a positive change in communication and family relationships scores for the Peds QL Family Impact Module (medium effect size
of 0.46 and 0.41, respectively).
Conclusions: In this pilot randomized trial of early PPC, mothers of children with SV heart disease experienced high levels of depression
and anxiety in the prenatal period. Early PPC in the SV population resulted in decreased maternal stress, improved maternal coping, and
improved communication and family relationships.
invasive and complex care, resulting in significant maternal stress. In other complex, life-limiting illnesses among children, pediatric
palliative care (PPC) may mitigate maternal distress. We hypothesized early PPC in the SV population may have the same beneficial effect
upon mothers.
Methods: In this pilot trial of early PPC, mothers of infants with a prenatal diagnosis of SV completed 4 questionnaires measuring anxiety,
depression, coping, and quality of life/family functioning at a prenatal visit (not at initial diagnosis) and again at neonatal discharge. Infants
were randomized to receive early PPC (defined as initial consultation prior to surgery consisting of structured evaluation, psychosocial/
spiritual support, and communication between mothers and care providers) or usual care.
Results: Among 56 eligible subjects, forty mothers enrolled and completed baseline surveys; 38 neonates randomized (18 early PPC, 20
usual care) and 34 postnatal surveys were completed (3 neonates died, 1 mother declined). Baseline Beck Depression Index II and StateTrait
Anxiety Index (STAI) scores exceeded those of a normal pregnant sample (mean 13.76 ± SD 8.46 vs. 7.0 ± 5.0, and 46.34 ± 12.59
vs. 29.8 ± 6.35, respectively; both P=0.0001), but there were no significant differences between study groups. There was a significant
decrease in prenatal to postnatal STAI scores in the early PPC group (-7.6 vs. 0.3 in usual care, P=0.02). Significantly higher postnatal
Brief Cope Inventory scores for positive reframing, an adaptive response, were noted in the early PPC group (P=0.03). The early PPC
group had a positive change in communication and family relationships scores for the Peds QL Family Impact Module (medium effect size
of 0.46 and 0.41, respectively).
Conclusions: In this pilot randomized trial of early PPC, mothers of children with SV heart disease experienced high levels of depression
and anxiety in the prenatal period. Early PPC in the SV population resulted in decreased maternal stress, improved maternal coping, and
improved communication and family relationships.
Rights
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Citation List Month
April 2016 List
Citation
Hancock H; Pituch K; Uzark K; Bhat P; Fifer C; Silveira M, “Impact Of Early Palliative Care Intervention On Maternal Stress In Mothers Of Infants Prenatally Diagnosed With Single Ventricle Heart Disease: A Randomized Clinical Trial.,” Pediatric Palliative Care Library, accessed April 28, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10472.