Factors Associated With Palliative Care Birth Planning at a Pediatric Hospital

Area of Science:

• Perinatal palliative care
• Maternal-fetal medicine
• Quality improvement in healthcare

Background:

• Palliative care birth plans are crucial for families facing complex pregnancies.
• Understanding factors influencing the use of these plans is essential for equitable care.
• Previous research has not fully elucidated the predictors of birth plan engagement.

Purpose of the Study:

• To identify factors associated with the offering, completion, and goal-setting of palliative care birth plans.
• To analyze demographic and clinical predictors influencing birth plan utilization.
• To inform quality improvement initiatives for perinatal palliative care.

Main Methods:

• Retrospective observational study of 128 maternal-fetal dyads at a quaternary pediatric hospital.
• Analysis of medical records for birth plan receipt, completion, and goals of care (comfort-focused vs. other).
• Descriptive statistics, group comparisons, and logistic regression were used to identify predictors.

Main Results:

• 60% of dyads received birth plans, 30% completed them, and 31% had comfort-focused goals.
• Comfort-focused goals were associated with a higher likelihood of receiving a birth plan (OR=7.20).
• Non-Black minority races had lower odds of receiving birth plans; increased prenatal palliative care visits correlated with higher offer and completion rates.
• Neurological and genetic diagnoses increased odds of comfort-focused goals.

Conclusions:

• Significant variation exists in the offering of palliative care birth plans, necessitating quality improvement.
• Enhancing follow-up during prenatal palliative care may improve birth plan completion rates.
• Addressing racial disparities and specific diagnoses is crucial for equitable palliative care planning.