Rent Sharla, Titchiner Daniela, Rholl Erin, Lyle Allison, Diego Ellen, North Krysten, Rahiem Sahar, Garmon Avery, Gaffur Raziya, Shayo Aisa, Diez Recinos Ana Lucia, Lemmon Monica, Docherty Sharron L
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA.
Atrium Health Levine Children's Hospital, Charlotte, NC, USA; Department of Pediatrics, Wake Forest University School of Medicine, Charlotte, NC, USA.
Ann Palliat Med. 2024 Nov;13(6):1420-1448. doi: 10.21037/apm-24-87.
2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied.
In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process.
A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings.
Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.
每年有240万例新生儿死亡和260万例死产。超过98%的围产期死亡发生在低收入和中等收入国家。尽管围产期死亡负担沉重，但获得相关围产期姑息治疗和心理社会护理的机会却很差，且研究不足。
在本综述中，我们综合了来自低收入和中等收入国家的围产期姑息治疗文献。我们关注围产期姑息治疗的临床实践以及资源有限环境中正在使用的教育模式。我们采用系统的范围综述方法，遵循系统评价和Meta分析扩展的范围综述（PRISMA-ScR）清单。检索了PubMed、Scopus、Embase、Cochrane、CINAHL和全球健康（embsco）数据库。检索过程中没有设置日期或语言限制。使用Covidence进行研究选择，以促进分阶段的综述过程。
去除重复研究后，共保留10145篇文章。经过三阶段综述，81项研究纳入我们的分析。已发表的围产期姑息治疗文献中最大部分聚焦于临床护理（n = 44）。9项研究关注围产期姑息治疗的提供者培训，28项研究涉及父母或家庭经历。在纳入的研究中，84.9%的第一作者或最后作者来自低收入或中等收入国家，91.8%的手稿中有来自重点国家的作者。本范围综述的结果表明，医护人员和家庭希望获得反映当地文化和资源实际情况的更好的围产期姑息治疗指南。此外，提供者需要加强围产期姑息治疗技术和管理方法的培训，这些方法可应用于一系列临床环境。
全球围产期姑息治疗策略必须包括与家庭进行富有同情心的沟通、死产或新生儿死亡后的心理社会支持，以及为提供围产期姑息治疗的医护人员提供情感和心理健康支持。
