Skip to main content
Top
Published in: BMC Palliative Care 1/2015

Open Access 01-12-2015 | Research article

Counseling for personal care options at neonatal end of life: a quantitative and qualitative parent survey

Authors: Emily Shelkowitz, Sharon L. Vessella, Patricia O’Reilly, Richard Tucker, Beatrice E. Lechner

Published in: BMC Palliative Care | Issue 1/2015

Login to get access

Abstract

Background

The death of a newborn is a traumatic life changing event in the lives of parents. We hypothesized that bereaved parents of newborn infants want to have choices in the personal care of their infant at the end of life.

Methods

Parents who had suffered a perinatal or neonatal loss between 1 and 6 years before the survey in a regional level IV neonatal intensive care unit (NICU) and associated labor and delivery room were invited to participate. Parents chose between an online survey, paper survey or telephone interview. The survey included multiple choice and open ended questions.

Results

Parents prefer multiple options for the personal care of their infant at the end of life. Emergent themes were need for guidance by the medical team, memory making, feeling cared for and respected by staff, and regrets related to missed opportunities.

Conclusion

While parents differ in their preferences in utilizing specific personal care options for their infant’s end of life, they share a common preference for being presented with multiple options to choose from and in being guided and supported by healthcare providers, while being afforded the opportunity to make memories with their infant by bonding with and parenting them.
Appendix
Available only for authorised users
Literature
2.
go back to reference Radestad I, Steineck G, Nordin C, Sjogren B. Psychological complications after stillbirth--influence of memories and immediate management: population based study. BMJ. 1996;312(7045):1505–8.PubMedCentralCrossRefPubMed Radestad I, Steineck G, Nordin C, Sjogren B. Psychological complications after stillbirth--influence of memories and immediate management: population based study. BMJ. 1996;312(7045):1505–8.PubMedCentralCrossRefPubMed
3.
go back to reference Youngblut JM, Brooten D, Cantwell GP, del Moral T, Totapally B. Parent health and functioning 13 months after infant or child NICU/PICU death. Pediatr. 2013;132(5):e1295–1301.CrossRef Youngblut JM, Brooten D, Cantwell GP, del Moral T, Totapally B. Parent health and functioning 13 months after infant or child NICU/PICU death. Pediatr. 2013;132(5):e1295–1301.CrossRef
4.
go back to reference Shaw RJ, St John N, Lilo E, Jo B, Benitz W, Stevenson DK, et al. Prevention of traumatic stress in mothers of preterms: 6-month outcomes. Pediatr. 2014;134(2):e481–488.CrossRef Shaw RJ, St John N, Lilo E, Jo B, Benitz W, Stevenson DK, et al. Prevention of traumatic stress in mothers of preterms: 6-month outcomes. Pediatr. 2014;134(2):e481–488.CrossRef
5.
go back to reference Lasiuk GC, Comeau T, Newburn-Cook C. Unexpected: an interpretive description of parental traumas' associated with preterm birth. BMC Pregnancy Childbirth. 2013;13 Suppl 1:S13.PubMed Lasiuk GC, Comeau T, Newburn-Cook C. Unexpected: an interpretive description of parental traumas' associated with preterm birth. BMC Pregnancy Childbirth. 2013;13 Suppl 1:S13.PubMed
6.
go back to reference Cuisinier MC, Kuijpers JC, Hoogduin CA, de Graauw CP, Janssen HJ. Miscarriage and stillbirth: time since the loss, grief intensity and satisfaction with care. Eur J Obstet Gynecol Reprod Biol. 1993;52(3):163–8.CrossRefPubMed Cuisinier MC, Kuijpers JC, Hoogduin CA, de Graauw CP, Janssen HJ. Miscarriage and stillbirth: time since the loss, grief intensity and satisfaction with care. Eur J Obstet Gynecol Reprod Biol. 1993;52(3):163–8.CrossRefPubMed
7.
go back to reference Caeymaex L, Speranza M, Vasilescu C, Danan C, Bourrat MM, Garel M, et al. Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU. PLoS One. 2011;6(12):e28633.PubMedCentralCrossRefPubMed Caeymaex L, Speranza M, Vasilescu C, Danan C, Bourrat MM, Garel M, et al. Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU. PLoS One. 2011;6(12):e28633.PubMedCentralCrossRefPubMed
8.
go back to reference Caeymaex L, Jousselme C, Vasilescu C, Danan C, Falissard B, Bourrat MM, et al. Perceived role in end-of-life decision making in the NICU affects long-term parental grief response. Arch Dis Child Fetal Neonatal Ed. 2013;98(1):F26–31.CrossRefPubMed Caeymaex L, Jousselme C, Vasilescu C, Danan C, Falissard B, Bourrat MM, et al. Perceived role in end-of-life decision making in the NICU affects long-term parental grief response. Arch Dis Child Fetal Neonatal Ed. 2013;98(1):F26–31.CrossRefPubMed
9.
go back to reference Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study. Bjog. 2013;120(5):637–43.PubMedCentralCrossRefPubMed Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, Ayers S. Parents' experiences and satisfaction with care during the birth of their very preterm baby: a qualitative study. Bjog. 2013;120(5):637–43.PubMedCentralCrossRefPubMed
10.
go back to reference Gold KJ. Navigating care after a baby dies: a systematic review of parent experiences with health providers. J Perinatol. 2007;27(4):230–7.CrossRefPubMed Gold KJ. Navigating care after a baby dies: a systematic review of parent experiences with health providers. J Perinatol. 2007;27(4):230–7.CrossRefPubMed
11.
go back to reference Guillaume S, Michelin N, Amrani E, Benier B, Durrmeyer X, Lescure S, et al. Parents' expectations of staff in the early bonding process with their premature babies in the intensive care setting: a qualitative multicenter study with 60 parents. BMC Pediatr. 2013;13:18.PubMedCentralCrossRefPubMed Guillaume S, Michelin N, Amrani E, Benier B, Durrmeyer X, Lescure S, et al. Parents' expectations of staff in the early bonding process with their premature babies in the intensive care setting: a qualitative multicenter study with 60 parents. BMC Pediatr. 2013;13:18.PubMedCentralCrossRefPubMed
12.
go back to reference Downe S, Schmidt E, Kingdon C, Heazell AE. Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study. BMJ Open. 2013;3(2):e002237.PubMedCentralCrossRefPubMed Downe S, Schmidt E, Kingdon C, Heazell AE. Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study. BMJ Open. 2013;3(2):e002237.PubMedCentralCrossRefPubMed
13.
go back to reference Cortezzo DE, Sanders MR, Brownell EA, Moss K. End-of-Life Care in the Neonatal Intensive Care Unit: Experiences of Staff and Parents. Am J Perinatol. 2014;32(8):713–24.CrossRefPubMed Cortezzo DE, Sanders MR, Brownell EA, Moss K. End-of-Life Care in the Neonatal Intensive Care Unit: Experiences of Staff and Parents. Am J Perinatol. 2014;32(8):713–24.CrossRefPubMed
14.
go back to reference Kelley MC, Trinidad SB. Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy Childbirth. 2012;12:137.PubMedCentralCrossRefPubMed Kelley MC, Trinidad SB. Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy Childbirth. 2012;12:137.PubMedCentralCrossRefPubMed
15.
go back to reference Meyer EC, Ritholz MD, Burns JP, Truog RD. Improving the quality of end-of-life care in the pediatric intensive care unit: parents' priorities and recommendations. Pediatr. 2006;117(3):649–57.CrossRef Meyer EC, Ritholz MD, Burns JP, Truog RD. Improving the quality of end-of-life care in the pediatric intensive care unit: parents' priorities and recommendations. Pediatr. 2006;117(3):649–57.CrossRef
16.
go back to reference Dussel V, Kreicbergs U, Hilden JM, Watterson J, Moore C, Turner BG, et al. Looking beyond where children die: determinants and effects of planning a child's location of death. J Pain Symptom Manage. 2009;37(1):33–43.PubMedCentralCrossRefPubMed Dussel V, Kreicbergs U, Hilden JM, Watterson J, Moore C, Turner BG, et al. Looking beyond where children die: determinants and effects of planning a child's location of death. J Pain Symptom Manage. 2009;37(1):33–43.PubMedCentralCrossRefPubMed
17.
go back to reference van der Geest IM, Darlington AS, Streng IC, Michiels EM, Pieters R, van den Heuvel-Eibrink MM. Parents' experiences of pediatric palliative care and the impact on long-term parental grief. J Pain Symptom Manage. 2014;47(6):1043–53.CrossRefPubMed van der Geest IM, Darlington AS, Streng IC, Michiels EM, Pieters R, van den Heuvel-Eibrink MM. Parents' experiences of pediatric palliative care and the impact on long-term parental grief. J Pain Symptom Manage. 2014;47(6):1043–53.CrossRefPubMed
18.
go back to reference Tan JS, Docherty SL, Barfield R, Brandon DH. Addressing parental bereavement support needs at the end of life for infants with complex chronic conditions. J Palliat Med. 2012;15(5):579–84.PubMedCentralCrossRefPubMed Tan JS, Docherty SL, Barfield R, Brandon DH. Addressing parental bereavement support needs at the end of life for infants with complex chronic conditions. J Palliat Med. 2012;15(5):579–84.PubMedCentralCrossRefPubMed
19.
go back to reference Meadow J. LaW: Neonatal bioethics: The moral challenges of medical innovation. Baltimore: Johns Hopkins University Press; 2006. Meadow J. LaW: Neonatal bioethics: The moral challenges of medical innovation. Baltimore: Johns Hopkins University Press; 2006.
20.
go back to reference O'Leary J, Warland J. Untold stories of infant loss: the importance of contact with the baby for bereaved parents. J Fam Nurs. 2013;19(3):324–47.CrossRefPubMed O'Leary J, Warland J. Untold stories of infant loss: the importance of contact with the baby for bereaved parents. J Fam Nurs. 2013;19(3):324–47.CrossRefPubMed
21.
go back to reference Radestad I, Surkan PJ, Steineck G, Cnattingius S, Onelov E, Dickman PW. Long-term outcomes for mothers who have or have not held their stillborn baby. Midwifery. 2009;25(4):422–9.CrossRefPubMed Radestad I, Surkan PJ, Steineck G, Cnattingius S, Onelov E, Dickman PW. Long-term outcomes for mothers who have or have not held their stillborn baby. Midwifery. 2009;25(4):422–9.CrossRefPubMed
22.
go back to reference Erlandsson K, Warland J, Cacciatore J, Radestad I. Seeing and holding a stillborn baby: mothers' feelings in relation to how their babies were presented to them after birth--findings from an online questionnaire. Midwifery. 2013;29(3):246–50.CrossRefPubMed Erlandsson K, Warland J, Cacciatore J, Radestad I. Seeing and holding a stillborn baby: mothers' feelings in relation to how their babies were presented to them after birth--findings from an online questionnaire. Midwifery. 2013;29(3):246–50.CrossRefPubMed
23.
go back to reference Gohlish MC. Stillbirth. Midwife Health Visit Community Nurse. 1985;21(1):16–22.PubMed Gohlish MC. Stillbirth. Midwife Health Visit Community Nurse. 1985;21(1):16–22.PubMed
24.
go back to reference Brereton L, Gardiner C, Gott M, Ingleton C, Barnes S, Carroll C. The hospital environment for end of life care of older adults and their families: an integrative review. J Adv Nurs. 2012;68(5):981–93.CrossRefPubMed Brereton L, Gardiner C, Gott M, Ingleton C, Barnes S, Carroll C. The hospital environment for end of life care of older adults and their families: an integrative review. J Adv Nurs. 2012;68(5):981–93.CrossRefPubMed
25.
go back to reference Wright V, Prasun MA, Hilgenberg C. Why is end-of-life care delivery sporadic?: A quantitative look at the barriers to and facilitators of providing end-of-life care in the neonatal intensive care unit. Adv Neonatal Care. 2011;11(1):29–36.CrossRefPubMed Wright V, Prasun MA, Hilgenberg C. Why is end-of-life care delivery sporadic?: A quantitative look at the barriers to and facilitators of providing end-of-life care in the neonatal intensive care unit. Adv Neonatal Care. 2011;11(1):29–36.CrossRefPubMed
26.
go back to reference Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. Music therapy in an integrated pediatric palliative care program. Am J Hosp Palliat Care. 2009;26(6):449–55.CrossRefPubMed Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. Music therapy in an integrated pediatric palliative care program. Am J Hosp Palliat Care. 2009;26(6):449–55.CrossRefPubMed
27.
go back to reference Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatr. 2013;131(5):902–18.CrossRef Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatr. 2013;131(5):902–18.CrossRef
28.
go back to reference Blood C, Cacciatore J. Best practice in bereavement photography after perinatal death: qualitative analysis with 104 parents. BMC Psychol. 2014;2(1):15.PubMedCentralCrossRefPubMed Blood C, Cacciatore J. Best practice in bereavement photography after perinatal death: qualitative analysis with 104 parents. BMC Psychol. 2014;2(1):15.PubMedCentralCrossRefPubMed
29.
go back to reference Cacciatore J, Schnebly S, Froen JF. The effects of social support on maternal anxiety and depression after stillbirth. Health Soc Care Community. 2009;17(2):167–76.CrossRefPubMed Cacciatore J, Schnebly S, Froen JF. The effects of social support on maternal anxiety and depression after stillbirth. Health Soc Care Community. 2009;17(2):167–76.CrossRefPubMed
30.
go back to reference Meert KL, Shear K, Newth CJ, Harrison R, Berger J, Zimmerman J, et al. Follow-up study of complicated grief among parents eighteen months after a child's death in the pediatric intensive care unit. J Palliat Med. 2011;14(2):207–14.PubMedCentralCrossRefPubMed Meert KL, Shear K, Newth CJ, Harrison R, Berger J, Zimmerman J, et al. Follow-up study of complicated grief among parents eighteen months after a child's death in the pediatric intensive care unit. J Palliat Med. 2011;14(2):207–14.PubMedCentralCrossRefPubMed
31.
go back to reference Moseley KL, Church A, Hempel B, Yuan H, Goold SD, Freed GL. End-of-life choices for African-American and white infants in a neonatal intensive-care unit: a pilot study. J Natl Med Assoc. 2004;96(7):933–7.PubMedCentralPubMed Moseley KL, Church A, Hempel B, Yuan H, Goold SD, Freed GL. End-of-life choices for African-American and white infants in a neonatal intensive-care unit: a pilot study. J Natl Med Assoc. 2004;96(7):933–7.PubMedCentralPubMed
32.
go back to reference Widger K, Tourangeau AE, Steele R, Streiner DL. Initial development and psychometric testing of an instrument to measure the quality of children's end-of-life care. BMC Palliat Care. 2015;14(1):1.PubMedCentralCrossRefPubMed Widger K, Tourangeau AE, Steele R, Streiner DL. Initial development and psychometric testing of an instrument to measure the quality of children's end-of-life care. BMC Palliat Care. 2015;14(1):1.PubMedCentralCrossRefPubMed
33.
go back to reference Hinds PS, Burghen EA, Pritchard M. Conducting end-of-life studies in pediatric oncology. West J Nurs Res. 2007;29(4):448–65.CrossRefPubMed Hinds PS, Burghen EA, Pritchard M. Conducting end-of-life studies in pediatric oncology. West J Nurs Res. 2007;29(4):448–65.CrossRefPubMed
34.
go back to reference Elkington J, Stevenson M, Haworth N, Sharwood L. Using police crash databases for injury prevention research - a comparison of opt-out and opt-in approaches to study recruitment. Aust N Z J Public Health. 2014;38(3):286–9.CrossRefPubMed Elkington J, Stevenson M, Haworth N, Sharwood L. Using police crash databases for injury prevention research - a comparison of opt-out and opt-in approaches to study recruitment. Aust N Z J Public Health. 2014;38(3):286–9.CrossRefPubMed
35.
go back to reference Williams C, Cairnie J, Fines V, Patey C, Schwarzer K, Aylward J, et al. Construction of a parent-derived questionnaire to measure end-of-life care after withdrawal of life-sustaining treatment in the neonatal intensive care unit. Pediatr. 2009;123(1):e87–95.CrossRef Williams C, Cairnie J, Fines V, Patey C, Schwarzer K, Aylward J, et al. Construction of a parent-derived questionnaire to measure end-of-life care after withdrawal of life-sustaining treatment in the neonatal intensive care unit. Pediatr. 2009;123(1):e87–95.CrossRef
36.
go back to reference Nelson H, Mott S, Kleinman ME, Goldstein RD. Parents' Experiences of Pediatric Palliative Transports: A Qualitative Case Series. J Pain Symptom Manage. 2015;50(3):375–80.CrossRefPubMed Nelson H, Mott S, Kleinman ME, Goldstein RD. Parents' Experiences of Pediatric Palliative Transports: A Qualitative Case Series. J Pain Symptom Manage. 2015;50(3):375–80.CrossRefPubMed
37.
go back to reference Kars MC, Grypdonck MH, de Bock LC, van Delden JJ. The parents' ability to attend to the "voice of their child" with incurable cancer during the palliative phase. Health Psychol. 2015;34(4):446–52.CrossRefPubMed Kars MC, Grypdonck MH, de Bock LC, van Delden JJ. The parents' ability to attend to the "voice of their child" with incurable cancer during the palliative phase. Health Psychol. 2015;34(4):446–52.CrossRefPubMed
38.
go back to reference Miller SJ, Hope T, Talbot DC. The development of a structured rating schedule (the BAS) to assess skills in breaking bad news. Br J Cancer. 1999;80(5–6):792–800.PubMedCentralCrossRefPubMed Miller SJ, Hope T, Talbot DC. The development of a structured rating schedule (the BAS) to assess skills in breaking bad news. Br J Cancer. 1999;80(5–6):792–800.PubMedCentralCrossRefPubMed
39.
go back to reference Tobler K, Grant E, Marczinski C. Evaluation of the impact of a simulation-enhanced breaking bad news workshop in pediatrics. Simul Healthc. 2014;9(4):213–9.CrossRefPubMed Tobler K, Grant E, Marczinski C. Evaluation of the impact of a simulation-enhanced breaking bad news workshop in pediatrics. Simul Healthc. 2014;9(4):213–9.CrossRefPubMed
Metadata
Title
Counseling for personal care options at neonatal end of life: a quantitative and qualitative parent survey
Authors
Emily Shelkowitz
Sharon L. Vessella
Patricia O’Reilly
Richard Tucker
Beatrice E. Lechner
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2015
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-015-0063-6

Other articles of this Issue 1/2015

BMC Palliative Care 1/2015 Go to the issue