Provision of Services in Perinatal Palliative Care: A Multicenter Survey in the United States.

BACKGROUND: Congenital anomalies account for 20% of neonatal and infant deaths in the United States. Perinatal palliative care is a recent addition to palliative care and is meant to meet the needs of families who choose to continue a pregnancy affected by a life-limiting diagnosis. OBJECTIVE: To examine characteristics of programs and services provided, assess alignment with the National Consensus Project domains of care, and identify providers and disciplines involved in programs. DESIGN: A cross-sectional survey design included 48 items addressing funding and domains of quality care. SUBJECTS: Program representatives from 30 states (n = 75). PRINCIPAL RESULTS: Perinatal palliative care programs are housed in academic medical centers, regional or community hospitals, local hospices, or community-based organizations. Significant differences by program setting were observed for type of fetal diagnoses seen, formal training in communicating bad news to parents, mechanisms to ensure continuity of care, and reimbursement mechanisms. One hundred percent of programs provided attention to spiritual needs and bereavement services; 70% of programs are less than 10 years old. Follow-up with parents to assess whether goals were met occurs at 43% of the perinatal palliative care programs. Formal measures of quality assessment were articulated in 38% of programs. CONCLUSION: This study dramatically adds to the literature available on perinatal palliative care program settings, types, and domains of care. It is clear that there are a variety of types of programs and that the field is still developing. More work is needed to determine which quality measures are needed to address perinatal care needs in this population.

Comfort levels of active duty gay/bisexual male service members in the military healthcare system.

Before a revision of the "Don't Ask, Don't Tell" policy in 2010, sexual behaviors that lesbian, gay, and bisexual service members disclosed to military healthcare providers (MHCPs) were grounds for discharge. However, after the revision, service members either did not know about the revision, or were still uncomfortable approaching MHCPs. This study examined the comfort levels of active duty gay/bisexual males approaching MHCPs about sexuality/sexual health concerns. Using a quantitative descriptive approach, the 31-item survey developed for this study provided initial research data to inform future studies on this topic. The survey was available to participants from March 2 to April 3, 2012. Analyzing responses from 30 participants, the data revealed a strong correlation between service members' comfort disclosing their sexual orientation to a MHCP and their perception of how the military cares about them as a sexual minority. The data suggested differences in comfort levels among age cohorts disclosing their sexual orientation, in addition to differences between officers and enlisted men concerning the cost of seeing a nonmilitary healthcare provider. MHCPs should understand that establishing a relationship with service members that encourages disclosure can improve their view of the military healthcare system and help address sexual health concerns.