Interventions to improve parent satisfaction with care in neonatal intensive care units: a systematic review

Presented at the Neonatal Society Spring Meeting 2019.

Authors: S. Sakonidou1, I. Andrzejewska1, J. Webbe1, N. Modi1, D. Bell2, C. Gale1.

Institution(s)
1 Imperial College London, Neonatal Medicine, London, United Kingdom.
2 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Northwest London, London, United Kingdom.

Introduction
Healthcare staff increasingly use satisfaction with neonatal care as a parent experience measure and service quality indicator. Interventions aimed at improving parent satisfaction can help reduce parent stress, and potentially improve parent-infant bonding (1) and infant outcomes (2). Objective: To conduct a systematic review of interventions to improve parent satisfaction with neonatal care. To conduct a systematic review of interventions to improve parent satisfaction with neonatal care.

Methods
We conducted a literature search (MEDLINE, EMBASE, PsychINFO, Cochrane Central, CINAHL, HMIC, Maternity and Infant Care), 1/1/1946-1/10/2017. We included studies of parents of babies receiving neonatal care and interventions aiming to improve parent satisfaction; randomised controlled trials and non-randomised comparative studies assessing ≥1 quantitative outcome were eligible. We extracted interventions, their impact on parent satisfaction, parent satisfaction definitions and measurements, and parent input into design of the interventions. We assessed methodological quality with the Cochrane Collaboration risk of bias tool (randomised) and the ROBINS-I tool (non-randomised studies). Funding: NIHR Fellowship grant (2017-10-172).

Results
We identified 32 studies with parent satisfaction measures from over 2900 parents and grouped interventions into 5 themes: parent involvement (e.g. parental presence at clinical rounds); parent emotional support (e.g. narrative writing); clinical care (e.g. co-bedding infants in incubators); information provision (e.g. Short Message Services (SMS) for parents); other (e.g. free parent parking). Of 32 studies 18 (56%) reported higher parent satisfaction in the intervention group. The theme with most studies reporting higher satisfaction was parent involvement (10/14). Parent satisfaction was measured by 334 different questions in 29 questionnaires (23/29 partially or completely unvalidated). Five (5/32, 16%) studies reported involving parents in intervention design. We assessed all studies as having high risk of bias.

Conclusions
Many interventions, commonly relating to parent involvement, are reported to improve parent satisfaction with neonatal care. However, inconsistency in definition and measurement of parent satisfaction and high risk of bias in all studies makes this low quality evidence. Standardised definitions and validated parent satisfaction measures are needed, as well as higher quality trials of parent experience.

References

1. Lopez-Maestro et al. Quality of attachment in infants less than 1500g or less than 32 weeks. Related factors.
   Early Hum Dev. 2016;104:1-6 2. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, et al. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. 2017;139(1)

Corresponding author e-mail address: s.sakonidou@imperial.ac.uk

Senior author supporting presentation on day of meeting: Dr Christopher Gale