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Vol 17, No 2 (2023)
Review paper
Published online: 2023-04-18
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Accessibility and challenges of perinatal palliative care in Poland

Urszula Tataj-Puzyna1, Beata Szlendak2, Izabela Kaptacz3, Dorota Sys4, Maria Węgrzynowska1, Barbara Baranowska1
DOI: 10.5603/PMPI.a2023.0015
·
Palliat Med Pract 2023;17(2):111-120.
Affiliations
  1. Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
  2. Foundation for Supporting Midwives, Warsaw, Poland
  3. Department of Palliative Medicine and Palliative Care, Chair of Nursery, Medical University of Silesia in Katowice, Poland
  4. Department of Medical Statistics, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland

open access

Vol 17, No 2 (2023)
Review paper
Published online: 2023-04-18

Abstract

Background: This article examines the legal status and level of accessibility to perinatal palliative care (PPC) in Poland, with a focus on the number of services provided and the number of parents receiving PPC services.

Material and methods: The desk research was based on information obtained from the National Health Fund regarding the number of units that signed a contract for the provision of guaranteed PPC services from 2018 to the first half (January–June) of 2022; the number of parents receiving the service from 2018 to 2022; and the number of services provided by a doctor, a psychologist and by primary care midwives (PCMs). In addition, the Map of Health Needs and National Transformation Plan data were used to prepare the data.

Results: In Poland, since 2018, PPC services have been provided with public funds under contracts signed with the National Health Fund. Since 2022, these type of services has been provided by 17 centres. Care was provided to 1,860 pregnant women diagnosed with lethal foetal anomaly and to four fathers. There are still voivodeships in which there is a lack of provision of PPC services that are financed from the state budget.

Conclusions: In Poland, there is no full accessibility to publicly funded PPC in every voivodeship. The lack of a sufficient number of PPC centres and the lack of a uniform national standard of practice for this type of care — provided in hospices, hospitals and home settings — prevents women from having continuity of professional perinatal care. There is a need to ensure the quality of the services provided and make progress towards the employment of midwives in PPC facilities by service providers to ensure that women receive obstetric care from the moment of an adverse diagnosis, professional preparation for childbirth and the postnatal period.

Abstract

Background: This article examines the legal status and level of accessibility to perinatal palliative care (PPC) in Poland, with a focus on the number of services provided and the number of parents receiving PPC services.

Material and methods: The desk research was based on information obtained from the National Health Fund regarding the number of units that signed a contract for the provision of guaranteed PPC services from 2018 to the first half (January–June) of 2022; the number of parents receiving the service from 2018 to 2022; and the number of services provided by a doctor, a psychologist and by primary care midwives (PCMs). In addition, the Map of Health Needs and National Transformation Plan data were used to prepare the data.

Results: In Poland, since 2018, PPC services have been provided with public funds under contracts signed with the National Health Fund. Since 2022, these type of services has been provided by 17 centres. Care was provided to 1,860 pregnant women diagnosed with lethal foetal anomaly and to four fathers. There are still voivodeships in which there is a lack of provision of PPC services that are financed from the state budget.

Conclusions: In Poland, there is no full accessibility to publicly funded PPC in every voivodeship. The lack of a sufficient number of PPC centres and the lack of a uniform national standard of practice for this type of care — provided in hospices, hospitals and home settings — prevents women from having continuity of professional perinatal care. There is a need to ensure the quality of the services provided and make progress towards the employment of midwives in PPC facilities by service providers to ensure that women receive obstetric care from the moment of an adverse diagnosis, professional preparation for childbirth and the postnatal period.

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Keywords

perinatal palliative care, perinatal hospices, midwife, health services, lethal foetal anomaly

About this article
Title

Accessibility and challenges of perinatal palliative care in Poland

Journal

Palliative Medicine in Practice

Issue

Vol 17, No 2 (2023)

Article type

Review paper

Pages

111-120

Published online

2023-04-18

Page views

1275

Article views/downloads

248

DOI

10.5603/PMPI.a2023.0015

Bibliographic record

Palliat Med Pract 2023;17(2):111-120.

Keywords

perinatal palliative care
perinatal hospices
midwife
health services
lethal foetal anomaly

Authors

Urszula Tataj-Puzyna
Beata Szlendak
Izabela Kaptacz
Dorota Sys
Maria Węgrzynowska
Barbara Baranowska

References (44)
  1. Wool C. Systematic review of the literature: parental outcomes after diagnosis of fetal anomaly. Adv Neonatal Care. 2011; 11(3): 182–192.
    CrossRefPubMed
  2. Wool C. Clinician confidence and comfort in providing perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2013; 42(1): 48–58.
    CrossRefPubMed
  3. Sun S, Yang M, Zhang J, et al. Family support for pregnant women with foetal abnormality requiring pregnancy termination in China. Health Soc Care Community. 2020; 28(3): 1020–1029.
    CrossRefPubMed
  4. Best S, Wou K, Vora N, et al. Promises, pitfalls and practicalities of prenatal whole exome sequencing. Prenat Diagn. 2018; 38(1): 10–19.
    CrossRefPubMed
  5. Ramesh A, Parvathi VD. Prenatal diagnosis: A connotation on genetic counseling being indispensable. Indian J Public Health. 2020; 64(1): 83–85.
    CrossRefPubMed
  6. Korzeniewska-Eksterowicz A, Respondek-Liberska M, Przysło Ł, et al. Perinatal palliative care: barriers and attitudes of neonatologists and nurses in Poland. ScientificWorldJournal. 2013; 2013: 168060.
    CrossRefPubMed
  7. Castańeda J, Oberszyn E. Wrodzone wady rozwojowe, zesoły genetyczne, wady letalne - możliwości diagnostyczne, roblemy kliniczne. Praktyka kliniczna, Etyka, Prawo, Psychologia. In: Rutkowska M, Szczepaniak S. ed. Postępowanie paliatywne w opiece perinatalnej. PZWL Wydawnictwo Lekarskie, Warszawa 2018: 47–65.
  8. Jones K, Baird K, Fenwick J. Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: A qualitative meta-synthesis. Midwifery. 2017; 50: 42–54.
    CrossRefPubMed
  9. Kamranpour B, Noroozi M, Bahrami M. Supportive needs of women who have experienced pregnancy termination due to fetal abnormalities: a qualitative study from the perspective of women, men and healthcare providers in Iran. BMC Public Health. 2019; 19(1): 507.
    CrossRefPubMed
  10. Cope H, Garrett ME, Gregory S, et al. Pregnancy continuation and organizational religious activity following prenatal diagnosis of a lethal fetal defect are associated with improved psychological outcome. Prenat Diagn. 2015; 35(8): 761–768.
    CrossRefPubMed
  11. Wyrok Trybunału Konstytucyjnego z dnia 22 października 2020 r. sygn. akt K 1/20 Ruling of the Constitutional Court [Internet]. 2020. https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20210000175 (5.01.2023).
  12. Côté-Arsenault D, Denney-Koelsch E. "Have no regrets:" Parents' experiences and developmental tasks in pregnancy with a lethal fetal diagnosis. Soc Sci Med. 2016; 154: 100–109.
    CrossRefPubMed
  13. Côté-Arsenault D, Denney-Koelsch E. “Love is a choice”: couple responses to continuing pregnancy with a lethal fetal diagnosis. Illness, Crisis & Loss. 2017; 26(1): 5–22.
    CrossRef
  14. Tataj-Puzyna U, Węgrzynowska M, Ryś M, et al. "This pregnancy makes sense": Experiences of women who have decided to continue pregnancy after lethal fetal diagnosis. Death Stud. 2023; 47(2): 149–158.
    CrossRefPubMed
  15. Cole JCM, Moldenhauer JS, Jones TR, et al. et al.. A proposed model for perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2017; 46(6): 904–911.
    CrossRefPubMed
  16. Fleming V, Iljuschin I, Pehlke-Milde J, et al. Dying at life׳s beginning: Experiences of parents and health professionals in Switzerland when an 'in utero' diagnosis incompatible with life is made. Midwifery. 2016; 34: 23–29.
    CrossRefPubMed
  17. Côté-Arsenault D, Denney-Koelsch E. "My baby is a person": parents' experiences with life-threatening fetal diagnosis. J Palliat Med. 2011; 14(12): 1302–1308.
    CrossRefPubMed
  18. Crawford A, Hopkin A, Rindler M, et al. Women’s experiences with palliative care during pregnancy. J Obstet Gynecol Neonatal Nurs. 2021; 50(4): 402–411.
    CrossRefPubMed
  19. Wool C. State of the science on perinatal palliative care. J Obstet Gynecol Neonatal Nurs. 2013; 42(3): 372–82; quiz E54.
    CrossRefPubMed
  20. Kobler K, Limbo R. Making a case: creating a perinatal palliative care service using a perinatal bereavement program model. J Perinat Neonatal Nurs. 2011; 25(1): 32–41; quiz 42.
    CrossRefPubMed
  21. Jalowska A, Krzeszowiak J, Stembalska A, et al. [Perinatal palliative care performed in obstetrics and neonatology wards and hospices for children - own experience]. Dev Period Med. 2019; 23(4): 253–262.
    PubMed
  22. Martín-Ancel A, Pérez-Muñuzuri A, González-Pachec N, et al. Perinatal palliative care. Anales Pediatría; 96(1): 60.e1–60.e7.
    CrossRef
  23. Rozporządzenie Ministra Zdrowia z dnia 31 stycznia 2017 r. zmieniające rozporządzenie w sprawie świadczeń gwarantowanych z zakresu opieki paliatywnej i hospicyjnej. Dz. U. z 2017r., poz. 236 2017.
  24. Komunikat Prezesa Narodowego Funduszu Zdrowia z dnia 6 lipca 2022 r. dotyczący perinatalnej opieki paliatywnej.
  25. Obwieszczenie Ministra Zdrowia z dnia 17 grudnia 2021 w sprawie jednloitego tekstu rozporządzenia Ministra Zdrowia w sprawie świadczeń gwarantowanych z zakresu opieki paliatywnej i hospicyjnej (Dz.U. 2021 poz. 262). 262 Dec 17, 2021.
  26. Ciałkowska-Rysz A. An appraisal of the situation of palliative care in Poland in 2018. Palliattive Medicine. 2019; 11(4): 163–169.
    CrossRef
  27. Dzierżanowski T. Accessibility of palliative care for adults in Poland. Palliative Medicine. 2020; 12(2): 75–83.
    CrossRef
  28. Sobolewska E, Harasim-Piszczatowska E, Kułak-Bejda A, et al. Perinatal hospice – is there a need for such units to function in the opinion of Polish society? Palliative Medicine. 2021; 13(3): 145–152.
    CrossRef
  29. Obwieszczenie Ministra Zdrowia z dnia 27 sierpnia 2021 r. w sprawie mapy potrzeb zdrowotnych na okres od 1 stycznia 2022 r. do 31 grudnia 2026 r.
  30. Rozporządzenie Ministra Zdrowia z dnia 29 października 2013 r. w sprawie świadczeń gwarantowanych z zakresu opieki paliatywnej i hospicyjnej (t.j. Dz. U. z 2018r., poz.742). Dz. U. z 2018r., poz.742 2013.
  31. Denney-Koelsch E, Black BP, Côté-Arsenault D, et al. A survey of perinatal palliative care programs in the united states: structure, processes, and outcomes. J Palliat Med. 2016; 19(10): 1080–1086.
    CrossRefPubMed
  32. Ziegler TR, Kuebelbeck A. Close to home: perinatal palliative care in a community hospital. Adv Neonatal Care. 2020; 20(3): 196–203.
    CrossRefPubMed
  33. Denney-Koelsch EM, Côté-Arsenault D. Perinatal Palliative Care. A Clinical Guide. Springer Cham, Switzerland 2020: Available from: http://link.springer.com/10.1007/978-3-030-34751-2.
  34. Kuchemba-Hunter J. Compassion and community in perinatal palliative care: understanding the necessity of the patient perspective through narrative illustration. J Palliat Care. 2019; 34(3): 160–163.
    CrossRefPubMed
  35. Thienprayoon R, Grossoehme D, Humphrey L, et al. "There's just no way to help, and they did." parents name compassionate care as a new domain of quality in pediatric home-based hospice and palliative care. J Palliat Med. 2020; 23(6): 767–776.
    CrossRefPubMed
  36. Weaver MS, October T, Feudtner C, et al. "Good-Parent beliefs": research, concept, and clinical practice. Pediatrics. 2020; 145(6): e20194018.
    CrossRefPubMed
  37. Obwieszczenie Ministra Zdrowia z dnia 15 października 2021 r. w sprawie krajowego planu transformacji (Dz. U. z 2021r., poz. 80).
  38. Wool C, Côté-Arsenault D, Perry Black B, et al. Provision of services in perinatal palliative care: a multicenter survey in the united states. J Palliat Med. 2016; 19(3): 279–285.
    CrossRefPubMed
  39. Kelley MC, Trinidad SB. Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy Childbirth. 2012; 12(1): 137.
    CrossRefPubMed
  40. Zarządzenie NR 79/2022/DSOZ Prezesa Narodowego Funduszu Zdrowia z dnia 29 czerwca 2022 r. w sprawie warunków zawarcia i realizacji umów o udzielanie świadczeń opieki zdrowotnej w rodzaju podstawowa opieka zdrowotna. NR 79/2022/DSOZ 2022.
  41. Rozporządzenie Ministra Zdrowia z dnia 24 września 2013 r. w sprawie świadczeń gwarantowanych z zakresu podstawowej opieki zdrowotnej (t.j. z 2021 r. poz. 540. t. j. z 2021r., poz. 540 2013.
  42. Poryszewska A, Stefaniak M, Dmoch-Gajzlerska E, et al. Role and tasks of the midwife as a member of the hospice perinatal care team. Kwartalnik Naukowy Fides et Ratio. 2022; 3(51): 84–94.
    CrossRef
  43. Krzeszowiak J, nadzw. RŚ. The role and tasks of a midwife as a team member who takes care of the pregnant patient diagnosed with lethal fetal defect. Nursing Public Health. 2016; 6(1): 57–61.
    CrossRef
  44. Dangel T, Biały B. Standards: standards and medical procedures for pediatric palliative home care in hospices for children : standards for perinatal palliative care. Warsaw: The Warsaw Hospice for Children Foundation; 2019.

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