Wilpers Abigail B, Kobler Kathie, Schafer Robyn, Wilpers Melissa, Zeme Molly, Batten Janene, Canty Lucinda, Lorch Scott A
Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, United States.
Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA 19146, United States.
Health Aff Sch. 2025 Apr 15;3(5):qxaf081. doi: 10.1093/haschl/qxaf081. eCollection 2025 May.
As abortion care restrictions increase, a growing population is continuing pregnancies complicated by life-limiting fetal conditions, making it more critical than ever to evaluate the state of the evidence in perinatal palliative care (PPC). Perinatal palliative care provides interdisciplinary, person-centered care, integrating medical management with psychosocial and bereavement support to enable values-driven decision-making. This scoping review evaluates US-based evidence on the safety, effectiveness, acceptability, and equity of PPC, assessing how these findings relate to growing abortion restrictions. Analysis of 13 studies found that US PPC programs are understudied, with limited evidence on maternal health and neonatal comfort outcomes. Studies lacked use rates for all eligible individuals, preventing assessment of overall PPC uptake. Most PPC patients reported high satisfaction, citing compassionate care, emotional support, and parental validation. However, studies lacked diversity. None examined the experience of receiving PPC due to abortion restrictions. Existing PPC evidence is limited, leaving critical gaps in safety, effectiveness, acceptability, and equity-key factors in assessing whether PPC meets its intended goals and serves diverse populations. Our review highlights that evidence is insufficient to determine whether PPC can adequately support the growing, vulnerable patient population now directed into it by policy rather than choice.
随着堕胎护理限制的增加，越来越多的人在继续妊娠，这些妊娠因胎儿存在危及生命的状况而变得复杂，这使得评估围产期姑息治疗（PPC）的证据状况比以往任何时候都更加关键。围产期姑息治疗提供跨学科的、以患者为中心的护理，将医疗管理与心理社会和哀伤支持相结合，以促成基于价值观的决策。本综述评估了美国关于围产期姑息治疗的安全性、有效性、可接受性和公平性的证据，评估这些研究结果与日益增加的堕胎限制之间的关系。对13项研究的分析发现，美国的围产期姑息治疗项目研究不足，关于孕产妇健康和新生儿舒适度结果的证据有限。研究缺乏所有符合条件个体的使用率，无法评估围产期姑息治疗的总体接受情况。大多数围产期姑息治疗患者表示高度满意，称赞护理富有同情心、提供情感支持以及给予父母认可。然而，研究缺乏多样性。没有一项研究考察因堕胎限制而接受围产期姑息治疗的经历。现有的围产期姑息治疗证据有限，在安全性、有效性、可接受性和公平性方面存在关键差距，而这些是评估围产期姑息治疗是否实现其预期目标并服务于不同人群的关键因素。我们的综述强调，现有证据不足以确定围产期姑息治疗能否充分支持目前因政策而非个人选择而转向该治疗的不断增加的脆弱患者群体。
