Components of perinatal palliative care: a systematic review protocol

Abstract

Background When a severe diagnosis is made before or shortly after birth, perinatal palliative care can be provided to support the infant, parents and involved healthcare providers. However, since this is a relatively new and evolving field of study, a large variation exists amongst perinatal palliative care initiatives internationally. The field currently lacks a systematic overview of effectiveness and working components of such initiatives.Methods A systematic search will be conducted in MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo and Web of Science. We will include quantitative and qualitative study designs examining the effect of perinatal palliative care compared to regular care provided on pain and/or symptom relief, quality of care for, and quality of life of fetuses/infants, parents, family members and involved healthcare providers; and quantitative and qualitative study designs describing the components of care included in existing perinatal palliative care initiatives. Three independent authors will review titles and abstracts and screen full texts against eligibility criteria. Two standardized scales will be used to assess the quality of included studies: one for quantitative research from the NHS Centre of Reviews and Dissemination guidelines for observational studies and for quantitative research, and one for qualitative research from Hawker critical appraisal tool for evaluating qualitative and mixed research. One reviewer will carry out full data extraction and quality assessment, and a 20% random sample will be extracted and assessed by two independent reviewers. An overview table of all identified perinatal palliative care initiatives, including their components and their (preliminary) effectiveness and measured outcome variables when applicable, will be construed. Our protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist for study protocols.Discussion This systematic review will provide a comprehensive overview of palliative care programs in the perinatal period and their working components. This will aid the construction of a reliable and valid perinatal palliative care intervention with the aim of developing and piloting a Perinatal Palliative Care program within the existing perinatal healthcare setting, in order to provide the best possible care for fetuses and neonates with a life-limiting diagnosis, their families, and involved healthcare providers.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

“…In LMICs, differences in the socio-cultural, religious/spiritual and legal environment, with limited and inconsistently available resources limit the applicability of evidence-based approaches derived in HICs. However, there are actionable steps that may address PC needs, improve bedside care and provide opportunity to develop research-informed interventions (50).…”

“…Due to the varied social, cultural, and resource considerations perinatal palliative care and bereavement interventions designed for HICs may not be applicable for the needs of LMICs (50). Research into parents' preferences in bereavement care, in sub-Saharan Africa is currently limited (46); further investigation is much needed.…”

“…Parents should be asked about any preferences for religious or cultural practices that they desire for their infant, and all reasonable efforts to honor these requests should be made to preserve dignity and respect for the patient and family (13). This could mean engaging religious and traditional leaders considered to be beneficial due to their societal stature, heritage, or clerical stature (47,50).…”

“…Individual parents may also differ on their preferences for memory-making and bonding, and these preferences may be influenced by cultural norms (47). Opportunities for parents to take photographs of their infants, and, if possible, to retain mementos from the hospitalization such as blankets the baby was wrapped in, clothing or a hat that the child wore may be meaningful and comforting to parents in processing their grief (50). However, care should be taken to ensure that such items are not contaminated with potentially infectious body fluids or fomites.…”

“…Perinatal PC intervention development efforts must be aware of cultural variations in beliefs and customs, while recognizing that pregnancy is a highly personal experience (46). Further research into how core elements of HIC bereavement care packages can translate to LMICs and what new, culturally tailored, interventions need to be developed to guide practice is warranted (50).…”