AUTHOR=Kovacevic Alexander , Simmelbauer Andreas , Starystach Sebastian , Elsässer Michael , Müller Andreas , Bär Stefan , Gorenflo Matthias 

TITLE=Counseling for Prenatal Congenital Heart Disease—Recommendations Based on Empirical Assessment of Counseling Success

JOURNAL=Frontiers in Pediatrics

VOLUME=8

YEAR=2020

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2020.00026

DOI=10.3389/fped.2020.00026

ISSN=2296-2360

ABSTRACT=<p><bold>Objectives:</bold> Empirical assessment of parental needs and affecting factors for counseling success after prenatal diagnosis of congenital heart disease (CHD).</p><p><bold>Methods:</bold>Counseling success after fetal diagnosis of CHD was assessed by a validated standardized questionnaire. The dependent variable “Effective Counseling” was measured in five created analytical dimensions (1. “Transfer of Medical Knowledge—<italic>ToMK</italic>”; 2. “Trust in Medical Staff—<italic>TiMS</italic>”; 3. “Transparency Regarding the Treatment Process—<italic>TrtTP</italic>”; 4. “Coping Resources—<italic>CR</italic>”; 5. “Perceived Situational Control–<italic>PSC</italic>”). Analyses were conducted with regard to influencing factors and correlations.</p><p><bold>Results:</bold> Sixty-one individuals (<italic>n</italic> = 40 females, <italic>n</italic> = 21 males) were interviewed in a tertiary medical care center. Median gestational age at first parental counseling was 28 + 6 weeks. Parental counseling was performed four times (median), mostly by pediatric cardiologists (83.6%). Overall counseling was successful in 46.3%, satisfying in 51.9%, and unsuccessful in 1.9%. Analyses of the analytical dimensions show that counseling was less successful for TOMK (38.3%) and PSC (39%); success rates were higher if additional written information or links to web sources were provided (60 and 70%, respectively). Length of consultation was positively correlated to counseling success for ToMK (<italic>r</italic> = 0.458), TrtTP (<italic>r</italic> = 0.636), PSC (<italic>r</italic> = 0.341), and TiMS (<italic>r</italic> = 0.501). Interruptions were negatively correlated to the dimensions TiMS (<italic>r</italic> = −0.263), and TrtTP (<italic>r</italic> = −0.210). In the presence of high-risk CHD (37.5%) overall counseling success was lower (26.1%). By cross table analysis and to a low degree of positive correlation in one dimension (ToMK; <italic>r</italic> = 0.202), counseling tends to be less successful for ToMK, TrtTP, and TiMS if parents have not been counseled by cardiologists. Analyses regarding premises show a parental need for a separate counseling room, which significantly impacts ToMK (<italic>r</italic> = −0,390) and overall counseling success (<italic>r</italic> = −0.333). A language barrier was associated with lower success rates for ToMK, TiMS, and CR (21.4, 42.9, and 30.8%).</p><p><bold>Conclusions:</bold> Data from this multidisciplinary study indicate that parents after fetal diagnosis of CHD need uninterrupted counseling of adequate duration and quality in a separate counseling room. Providing additional written information or links to adequate web sources after initial counseling seems necessary. High-risk CHD needs more attention for counseling. There is a trend towards more counseling success if provided by cardiologists.</p>