Are we offering palliative care and employing shared decision making in the neonatal intensive care unit? A 10-year retrospective chart review

PEC innovation Pub Date : 2025-01-16 DOI:10.1016/j.pecinn.2025.100375

Sawyer Karabelas-Pittman , Helen Coo , Hannah Lee , Christine C. Moon , Gillian MacLean

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Abstract

Objective

Perinatal palliative care (PPC) supports families with a fetal diagnosis of a life-limiting condition or who are facing preterm labour at the limits of viability. Shared decision making (SDM) is the gold standard approach in PPC. The objectives of this study were to describe the Neonatal Intensive Care Unit (NICU) team's involvement in PPC and the extent of SDM at an academic hospital in southeastern Ontario, and the frequency with which PPC was offered, accepted and received for live births.

Methods

We retrospectively reviewed charts for births from January 2010–January 2020 where a life-limiting condition (LLC) had been prenatally diagnosed or there was threatened preterm labour (TPTL) at the limits of viability. Frequency distributions were used to summarize the NICU team's involvement, extent of SDM, and data related to PPC provision.

Results

The LLC group included 73 patients. The NICU team was consulted for 26 (36 %). Among the 10 consults that involved decision making, SDM was documented in 9 instances (90 %). PPC was offered to 9 of 60 LLC families (15 %) with a live birth and was accepted by 8 (89 %). The TPTL Group included 112 patients. Seventy (62 %) received a consult with the NICU team. SDM was documented in 34 of 39 consults (87 %) that involved decision making. PPC was offered to 28 of 90 families (31 %) who experienced a live birth and was accepted by 16 (57 %).

Conclusion

Our results demonstrate the need for standardized consultation and palliative care referral protocols to advance access to and quality of neonatal end-of-life care.

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我们是否提供姑息治疗，并在新生儿重症监护室采用共同决策？10年回顾性图表回顾

目的围产期姑息治疗（PPC）支持胎儿诊断为生命受限条件或面临生存能力极限的早产的家庭。共享决策（SDM）是PPC的黄金标准方法。本研究的目的是描述安大略省东南部一家学术医院新生儿重症监护病房（NICU）团队参与PPC和SDM的程度，以及为活产婴儿提供、接受和接受PPC的频率。方法回顾性分析2010年1月至2020年1月产前诊断为生命限制状况（LLC）或生存能力极限时存在威胁性早产（TPTL）的新生儿图表。频率分布用于总结NICU团队的参与、SDM的程度以及与PPC提供相关的数据。结果LLC组73例。NICU小组咨询26例（36%）。在涉及决策制定的10个咨询中，SDM在9个实例中被记录（90%）。60个活产的LLC家庭中有9个（15%）接受了PPC， 8个（89%）接受了PPC。TPTL组包括112例患者。70例（62%）接受了NICU小组的会诊。39例涉及决策的咨询中有34例（87%）记录了SDM。90个活产家庭中有28个（31%）接受了PPC， 16个（57%）接受了PPC。结论我们的研究结果表明，需要标准化的咨询和姑息治疗转诊协议，以提高新生儿临终关怀的可及性和质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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