School of Nursing, Loma Linda University, Loma Linda, CA, USA.
LLUH Center for Evidence Synthesis: A JBI Affiliated Group, Loma Linda, CA, USA.
JBI Evid Synth. 2024 Oct 1;22(10):2003-2089. doi: 10.11124/JBIES-23-00149.
The objective of the scoping review was to explore the evidence and describe what is known about perinatal bereavement care guidelines provided within health care facilities prior to discharge. Additionally, the review sought to identify what is known about parents' mental health outcomes, and map these outcomes to the characteristics of the bereavement care guidelines.
Perinatal loss poses a serious risk of emotional trauma and mental health sequelae. Conflicting evidence for international bereavement care guidelines and inconsistent implementation, a lack of experimental studies, and older syntheses with a limited focus or population made synthesis complex. Therefore, a scoping review was undertaken to determine the breadth and depth of the existing literature on this topic.
Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and parents' mental health outcomes were included. Sources pertaining to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines were excluded.
The review was conducted using JBI methodology for scoping reviews. The team considered quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. CINAHL (EBSCOhost), PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Cochrane Library, JBI Evidence-based Practice Database (Ovid), Embase, PubMed, ProQuest Dissertations and Theses A&I (ProQuest), Web of Science Core Collection, and Epistemonikos were the major databases searched. OpenGrey, Google Scholar, and organizational websites were also searched. The earliest empirical study publication found (1976) served as the starting date limit. After pilot-testing the screening process, data were extracted, collated, and presented in narrative format as well as in tables and figures. The search was first conducted in September and October 2021, and an updated search was performed on February 9, 2023.
The results provide a broad view of bereavement care guidelines to support grieving parents' mental health. The included sources (n=195) were comprised of 28 syntheses, 96 primary studies, and 71 literature review/text and opinion. From the studies that specified the number of participants, 47,598 participants were included. Key characteristics of bereavement care guidelines were categorized as i) making meaning/memories, ii) good communication, iii) shared decision-making, iv) effective emotional and social support, and v) organizational response. Parents' reported mental health outcomes included both negative outcomes, such as depression, anxiety, anger, and helplessness, and positive outcomes, including coping, healing, recovery, and well-being.
Conceptually, the characteristics of published guidelines are fairly consistent across settings, with cultural variations in specific components of the guidelines. Despite the exponential increase in research on bereavement care after perinatal loss, there is a gap in research pertaining to certain characteristics of bereavement care guidelines that are accepted as best practice to support parents' mental health outcomes. This review provides support for future research given the trauma and mental health risks following perinatal loss. Policies ensuring consistent and appropriate implementation of bereavement care guidelines are essential to improve parents' mental health outcomes.
A Spanish-language version of the abstract of this review is available: http://links.lww.com/SRX/A66 .
本系统评价的目的是探讨现有的围产期丧亲护理指南，这些指南在出院前在医疗保健机构内提供，同时描述已知的父母心理健康结局，并将这些结局映射到丧亲护理指南的特征上。
围产期损失会带来严重的情绪创伤和心理健康后遗症风险。国际丧亲护理指南存在矛盾证据，实施情况不一致，缺乏实验研究，以及较旧的综合分析重点或人群有限，使得综合分析变得复杂。因此，进行了系统评价，以确定现有关于该主题的文献的广度和深度。
纳入了与围产期损失（流产、死产或新生儿死亡）后医疗保健机构中使用的丧亲护理指南以及父母心理健康结局相关的来源。排除了与父母以外的家庭成员、发生在医疗保健机构之外的围产期损失以及身体护理指南相关的来源。
本评价使用 JBI 方法进行了范围评价。团队考虑了定量和定性研究、实践指南、病例报告、专家意见、系统评价、专业组织网站和灰色文献。主要数据库包括 CINAHL（EBSCOhost）、PsycINFO（EBSCOhost）、SocINDEX（EBSCOhost）、Cochrane 图书馆、JBI 循证实践数据库（Ovid）、Embase、PubMed、ProQuest 学位论文和综合研究数据库（ProQuest）、Web of Science 核心合集和 Epistemonikos。还搜索了 OpenGrey、Google Scholar 和组织网站。最早的实证研究出版物（1976 年）被用作起始日期限制。在对筛选过程进行试点测试后，将数据提取、整理并以叙述形式以及表格和图形呈现。搜索于 2021 年 9 月和 10 月首次进行，并于 2023 年 2 月 9 日进行了更新搜索。
结果提供了支持悲伤父母心理健康的丧亲护理指南的广泛视图。纳入的来源（n=195）包括 28 项综合分析、96 项初级研究和 71 项文献综述/文本和意见。从指定参与者数量的研究中，包括 47598 名参与者。丧亲护理指南的关键特征分为 i）赋予意义/记忆，ii）良好的沟通，iii）共同决策，iv）有效的情感和社会支持，以及 v）组织反应。父母报告的心理健康结局包括负面结局，如抑郁、焦虑、愤怒和无助，以及积极的结局，如应对、康复、恢复和幸福感。
从概念上讲，发表的指南特征在各个环境中相当一致，指南的某些组成部分存在文化差异。尽管围产期丧亲后丧亲护理的研究呈指数级增长，但在被认为是支持父母心理健康结局的最佳实践的某些丧亲护理指南特征方面仍存在研究差距。鉴于围产期损失后的创伤和心理健康风险，本综述为未来的研究提供了支持。确保丧亲护理指南的一致和适当实施的政策对于改善父母的心理健康结局至关重要。
本评论的西班牙语版本摘要可在以下网址获取：http://links.lww.com/SRX/A66。
