Reducing Stress and Anxiety among Families by Introducing Prenatal Palliative Care

Abstract

Problem & Purpose: Critical congenital heart disease (CHD) is often diagnosed during the prenatal period. Families who receive this diagnosis are often not educated about what their lives will be like after the baby is born. Families of neonates with critical CHD at a large, academic medical center in Maryland report high levels of stress, anxiety, and difficulty coping with the CHD diagnosis and the postoperative process in the hospital. The purpose of this quality improvement initiative is to implement the practice change of a prenatal palliative care consult for families of patients with critical CHD. The main goal of the prenatal palliative care consult is to decrease the levels of stress and anxiety and improve coping in families of patients with critical CHD. Methods: Families met with the cardiac surgeons and then the clinical coordinator to discuss the predicted postoperative course. Prior to this meeting, a survey was sent to families via REDCap which included the following instruments: Brief COPE Inventory and Depression, Anxiety and Stress Scale (DASS-21). The meeting with the clinical coordinator included the prenatal palliative care consult. Families were provided with resources, psychosocial support, and care coordination. The same survey was sent to families after the consult. Results: Six referrals to palliative care were made and four consults were completed which means that 66.7% of eligible participants received a prenatal palliative care consult. Pre and post consult surveys were sent to all families that received a consult and two families completed the surveys which is a 50% response rate. The average anxiety, stress, and depression scores decreased on the DASS-21 survey from 7±1.41 to 3 ±1.41, 11 ±1.41 to 7 ±1.41, and 18 ± 5.66 to 14 ±0, respectively. The Brief COPE survey results showed improvement in some coping mechanisms scores including instrumental support, acceptance, and positive reframing. Conclusions: Due to the limited number of eligible participants in this project, it is difficult to make any sweeping conclusions. There is potential that a prenatal palliative care consult can decrease stress and anxiety and improve coping in families of patients with critical CHD based on the findings.