在中国新生儿重症监护病房测试家庭支持性临终关怀干预措施：一项采用非随机对照试验设计的准实验研究。
Testing a Family Supportive End of Life Care Intervention in a Chinese Neonatal Intensive Care Unit: A Quasi-experimental Study With a Non-randomized Controlled Trial Design.
作者信息
Zhang Rong, Tang Qian, Zhu Li-Hui, Peng Xiao-Ming, Zhang Na, Xiong Yue-E, Chen Mu-Hua, Chen Ke-Liang, Luo Dan, Li Xun, Latour Jos M
机构信息
Department of Neonatology, Hunan Children's Hospital, Changsha, China.
Department of Nursing, Hunan Children's Hospital, Changsha, China.
出版信息
Front Pediatr. 2022 Jul 22;10:870382. doi: 10.3389/fped.2022.870382. eCollection 2022.
BACKGROUND
Neonatal death often occurs in tertiary Neonatal Intensive Care Units (NICUs). In China, end-of-life-care (EOLC) does not always involve parents.
AIM
The aim of this study is to evaluate a parent support intervention to integrate parents at the end of life of their infant in the NICU.
METHODS
A quasi-experimental study using a non-randomized clinical trial design was conducted between May 2020 and September 2021. Participants were infants in an EOLC pathway in the NICU and their parents. Parents were allocated into a family supportive EOLC intervention group or a standard EOLC group based on their wishes. The primary outcomes depression (Edinburgh Postnatal Depression Scale for mothers; Hamilton Depression rating scale for fathers) and Satisfaction with Care were measured 1 week after infants' death. Student -test for continuous variables and the Chi-square test categorical variables were used in the statistical analysis.
RESULTS
In the study period, 62 infants died and 45 infants and 90 parents were enrolled; intervention group 20 infants, standard EOLC group 25 infants. The most common causes of death in both groups were congenital abnormalities ( = 20, 44%). Mean gestational age of infants between the family supportive EOLC group and standard EOLC group was 31.45 vs. 33.8 weeks ( = 0.234). Parents between both groups did not differ in terms of age, delivery of infant, and economic status. In the family support group, higher education levels were observed among mother ( = 0.026) and fathers ( = 0.020). Both mothers and fathers in the family supportive EOLC group had less depression compared to the standard EOLC groups; mothers (mean 6.90 vs. 7.56; = 0.017) and fathers (mean 20.7 vs. 23.1; < 0.001). Parents reported higher satisfaction in the family supportive EOLC group (mean 88.9 vs. 86.6; < 0.001).
CONCLUSIONS
Supporting parents in EOLC in Chinese NICUs might decreased their depression and increase satisfaction after the death of their infant. Future research needs to focus on long-term effects and expand on larger populations with different cultural backgrounds.
CLINICAL TRIAL REGISTRATION
www.ClinicalTrials.gov, identifier: NCT05270915.
背景
新生儿死亡常发生在三级新生儿重症监护病房（NICU）。在中国，临终关怀（EOLC）并不总是让父母参与其中。
目的
本研究旨在评估一项家长支持干预措施，以使父母参与到NICU中其婴儿的临终关怀过程。
方法
在2020年5月至2021年9月期间进行了一项采用非随机临床试验设计的准实验研究。参与者为NICU中处于临终关怀路径的婴儿及其父母。根据父母的意愿将他们分配到家庭支持性临终关怀干预组或标准临终关怀组。在婴儿死亡1周后测量主要结局指标抑郁情况（母亲采用爱丁堡产后抑郁量表；父亲采用汉密尔顿抑郁评定量表）和护理满意度。统计分析中对连续变量采用t检验，对分类变量采用卡方检验。
结果
在研究期间，62名婴儿死亡，45名婴儿和90名父母入组；干预组20名婴儿，标准临终关怀组25名婴儿。两组中最常见的死亡原因均为先天性异常（n = 20，44%）。家庭支持性临终关怀组与标准临终关怀组婴儿的平均胎龄分别为31.45周和33.8周（P = 0.234）。两组父母在年龄、婴儿分娩情况和经济状况方面无差异。在家庭支持组中，母亲（P = 0.026）和父亲（P = 0.020）的受教育程度较高。与标准临终关怀组相比，家庭支持性临终关怀组的母亲和父亲抑郁程度均较低；母亲（平均6.90 vs. 7.56；P = 0.017），父亲（平均20.7 vs. 23.1；P < 0.001）。家庭支持性临终关怀组的父母报告的满意度更高（平均88.9 vs. 86.6；P < 0.001）。
结论
在中国NICU中为父母提供临终关怀支持可能会减轻他们的抑郁情绪，并提高婴儿死亡后的满意度。未来的研究需要关注长期影响，并在更大规模、不同文化背景的人群中开展。
临床试验注册
Zotero 插件