Kovacevic Alexander, Simmelbauer Andreas, Starystach Sebastian, Elsässer Michael, Müller Andreas, Bär Stefan, Gorenflo Matthias
Department of Pediatric and Congenital Cardiology, Heidelberg University, Hospital, Heidelberg, Germany.
Max Weber Institute for Sociology, Ruprecht Karls University Heidelberg, Heidelberg, Germany.
Front Pediatr. 2020 Feb 26;8:26. doi: 10.3389/fped.2020.00026. eCollection 2020.
Empirical assessment of parental needs and affecting factors for counseling success after prenatal diagnosis of congenital heart disease (CHD). Counseling success after fetal diagnosis of CHD was assessed by a validated standardized questionnaire. The dependent variable "Effective Counseling" was measured in five created analytical dimensions (1. "Transfer of Medical Knowledge-"; 2. "Trust in Medical Staff-"; 3. "Transparency Regarding the Treatment Process-"; 4. "Coping Resources-"; 5. "Perceived Situational Control-"). Analyses were conducted with regard to influencing factors and correlations. Sixty-one individuals ( = 40 females, = 21 males) were interviewed in a tertiary medical care center. Median gestational age at first parental counseling was 28 + 6 weeks. Parental counseling was performed four times (median), mostly by pediatric cardiologists (83.6%). Overall counseling was successful in 46.3%, satisfying in 51.9%, and unsuccessful in 1.9%. Analyses of the analytical dimensions show that counseling was less successful for TOMK (38.3%) and PSC (39%); success rates were higher if additional written information or links to web sources were provided (60 and 70%, respectively). Length of consultation was positively correlated to counseling success for ToMK ( = 0.458), TrtTP ( = 0.636), PSC ( = 0.341), and TiMS ( = 0.501). Interruptions were negatively correlated to the dimensions TiMS ( = -0.263), and TrtTP ( = -0.210). In the presence of high-risk CHD (37.5%) overall counseling success was lower (26.1%). By cross table analysis and to a low degree of positive correlation in one dimension (ToMK; = 0.202), counseling tends to be less successful for ToMK, TrtTP, and TiMS if parents have not been counseled by cardiologists. Analyses regarding premises show a parental need for a separate counseling room, which significantly impacts ToMK ( = -0,390) and overall counseling success ( = -0.333). A language barrier was associated with lower success rates for ToMK, TiMS, and CR (21.4, 42.9, and 30.8%). Data from this multidisciplinary study indicate that parents after fetal diagnosis of CHD need uninterrupted counseling of adequate duration and quality in a separate counseling room. Providing additional written information or links to adequate web sources after initial counseling seems necessary. High-risk CHD needs more attention for counseling. There is a trend towards more counseling success if provided by cardiologists.
先天性心脏病（CHD）产前诊断后父母需求及影响咨询成功因素的实证评估。通过一份经过验证的标准化问卷评估胎儿CHD诊断后的咨询成功率。因变量“有效咨询”在五个创建的分析维度中进行衡量（1. “医学知识传递 -”；2. “对医务人员的信任 -”；3. “治疗过程的透明度 -”；4. “应对资源 -”；5. “感知情境控制 -”）。针对影响因素和相关性进行了分析。在一家三级医疗中心对61人（40名女性，21名男性）进行了访谈。首次父母咨询时的中位孕周为28 + 6周。父母咨询进行了四次（中位数），主要由儿科心脏病专家进行（83.6%）。总体咨询成功率为46.3%，满意度为51.9%，不成功的为1.9%。对分析维度的分析表明，在“医学知识传递”（38.3%）和“感知情境控制”（39%）方面咨询成功率较低；如果提供额外的书面信息或网络资源链接，成功率会更高（分别为60%和70%）。咨询时长与“医学知识传递”（r = 0.458）、“治疗过程透明度”（r = 0.636））、“感知情境控制”（r = 0.341）和“对医务人员的信任”（r = 0.501）的咨询成功率呈正相关。中断与“对医务人员的信任”（r = -0.26）和“治疗过程透明度”（r = -0.21）维度呈负相关。在存在高危CHD的情况下（37.5%），总体咨询成功率较低（26.1%）。通过交叉表分析以及在一个维度上存在低度正相关（“医学知识传递”；r = 0.202），如果父母未接受心脏病专家的咨询，在“医学知识传递”、“治疗过程透明度”和“对医务人员的信任”方面咨询往往不太成功。关于前提条件的分析表明，父母需要一个单独的咨询室，这对“医学知识传递”（r = -0.390）和总体咨询成功率（r = -0.333）有显著影响。语言障碍与“医学知识传递”、“对医务人员的信任”和“应对资源”的较低成功率相关（分别为21.4%、42.9%和30.8%）。这项多学科研究的数据表明，胎儿CHD诊断后的父母需要在一个单独的咨询室接受持续时间足够且质量良好的不间断咨询。在初次咨询后提供额外的书面信息或合适的网络资源链接似乎很有必要。高危CHD在咨询方面需要更多关注。由心脏病专家提供咨询时，咨询成功率有更高的趋势。
