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A randomised trial of early palliative care for maternal stress in infants prenatally diagnosed with single-ventricle heart disease

Published online by Cambridge University Press:  10 January 2018

Hayley S. Hancock ,
Ken Pituch ,
Karen Uzark ,
Priya Bhat Open the ORCID record for Priya Bhat [Opens in a new window] ,
Carly Fifer ,
Maria Silveira ,
Sunkyung Yu ,
Suzanne Welch ,
Janet Donohue  and
Ray Lowery
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Hayley S. Hancock*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Ward Family Heart Center, Children’s Mercy Kansas City, Missouri, United States of America
Ken Pituch
Affiliation:
Department of Pediatrics, Palliative Care, University of Michigan, Ann Arbor, Michigan, United States of America
Karen Uzark
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Priya Bhat
Affiliation:
Department of Pediatrics, School of Medicine, Divisions of Pediatric Cardiology and Critical Care Medicine, Washington University, St. Louis, Missouri, United States of America
Carly Fifer
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Maria Silveira
Affiliation:
Department of Internal Medicine, Division of Geriatric Medicine and Palliative Care, University of Michigan, Ann Arbor, Michigan, United States of America
Sunkyung Yu
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Suzanne Welch
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Janet Donohue
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Ray Lowery
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
Ranjit Aiyagari
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States of America
*
Correspondence to: H. S. Hancock, MD, Ward Family Heart Center, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108-4619, United States of America. Tel: +816 302 8277; Fax: +816 302 9987; E-mail: hshancock@cmh.edu
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Abstract

Children with single-ventricle disease experience high mortality and complex care. In other life-limiting childhood illnesses, paediatric palliative care may mitigate maternal stress. We hypothesised that early palliative care in the single-ventricle population may have the same benefit for mothers. In this pilot randomised trial of early palliative care, mothers of infants with prenatal single-ventricle diagnoses completed surveys measuring depression, anxiety, coping, and quality of life at a prenatal visit and neonatal discharge. Infants were randomised to receive early palliative care – structured evaluation, psychosocial/spiritual, and communication support before surgery – or standard care. Among 56 eligible mothers, 40 enrolled and completed baseline surveys; 38 neonates were randomised, 18 early palliative care and 20 standard care; and 34 postnatal surveys were completed. Baseline Beck Depression Inventory-II and State-Trait Anxiety Index scores exceeded normal pregnant sample scores (mean 13.76±8.46 versus 7.0±5.0 and 46.34±12.59 versus 29.8±6.35, respectively; p=0.0001); there were no significant differences between study groups. The early palliative care group had a decrease in prenatal to postnatal State-Trait Anxiety Index scores (−7.6 versus 0.3 in standard care, p=0.02), higher postnatal Brief Cope Inventory positive reframing scores (p=0.03), and a positive change in PedsQL Family Impact Module communication and family relationships scores (effect size 0.46 and 0.41, respectively). In conclusion, these data show that mothers of infants with single-ventricle disease experience significant depression and anxiety prenatally. Early palliative care resulted in decreased maternal anxiety, improved maternal positive reframing, and improved communication and family relationships.

Keywords

CHDhypoplastic left heart syndromeparental stresspaediatric palliative care
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 4 , April 2018 , pp. 561 - 570
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Copyright
© Cambridge University Press 2018 

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