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Flynn KE, McDonnell SM, Brazauskas R, Ahamed SI, McIntosh JJ, Pitt MB, Pizur-Barnekow K, Kim UO, Kruper A, Leuthner SR, Basir MA. Smartphone-Based Video Antenatal Preterm Birth Education: The Preemie Prep for Parents Randomized Clinical Trial. JAMA Pediatr 2023; 177:2807911. [PMID: 37523163 PMCID: PMC10481234 DOI: 10.1001/jamapediatrics.2023.1586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/09/2023] [Indexed: 08/01/2023]
Abstract
Importance Preterm birth is a leading cause of infant mortality and child morbidity. Preterm birth is not always unexpected, yet standard prenatal care does not offer anticipatory education to parents at risk of delivering preterm, which leaves parents unprepared to make health care choices during the pregnancy that can improve survival and decrease morbidity in case of preterm birth. Objective To evaluate the effect of the Preemie Prep for Parents (P3) program on maternal knowledge of preterm birth, preparation for decision-making, and anxiety. Design, Setting, and Participants Recruitment for this randomized clinical trial conducted at a US academic medical center took place from February 3, 2020, to April 12, 2021. A total of 120 pregnant persons with a risk factor for preterm birth were enrolled between 16 and 21 weeks' gestational age and followed up through pregnancy completion. Intervention Starting at 18 weeks' gestational age, P3 program participants received links delivered via text message to 51 gestational age-specific short animated videos. Control participants received links to patient education webpages from the American College of Obstetricians and Gynecologists. Main Outcomes and Measures At 25 weeks' gestation, scores on the Parent Prematurity Knowledge Questionnaire (scored as percent correct), Preparation for Decision Making Scale (scored 0-100), and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety computerized adaptive test. Analysis was based on an intention to treat. Results A total of 120 pregnant participants (mean [SD] age, 32.5 [4.9] years) were included in the study; 60 participants were randomized to each group. Participants in the P3 group scored higher than those in the control group on knowledge of long-term outcomes at 25 weeks (88.5% vs 73.2%; estimated difference, 15.3 percentage points; 95% CI, 8.3-22.5 percentage points; P < .001). Participants in the P3 group reported being significantly more prepared than did participants in the control group for neonatal resuscitation decision-making at 25 weeks (Preparation for Decision Making Scale score, 76.0 vs 52.3; difference, 23.7; 95% CI, 14.1-33.2). There was no difference between the P3 group and the control group in anxiety at 25 weeks (mean [SE] PROMIS Anxiety scores, 53.8 [1.1] vs 54.0 [1.1]; difference, -0.1; 95% CI, -3.2 to 2.9). Conclusions and Relevance In this randomized clinical trial, pregnant persons randomly assigned to the P3 program had more knowledge of core competencies and were more prepared to make decisions that affect maternal and infant health, without experiencing worse anxiety. Mobile antenatal preterm birth education may provide a unique benefit to parents with preterm birth risk factors. Trial Registration ClinicalTrials.gov Identifier: NCT04093492.
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Affiliation(s)
| | | | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - S. Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin
| | | | - Michael B. Pitt
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis
| | | | - U. Olivia Kim
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, Illinois
| | - Abbey Kruper
- Department of Obstetrics & Gynecology, Medical College of Wisconsin, Milwaukee
| | | | - Mir A. Basir
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
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2
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van den Heuvel JFM, Hogeveen M, Lutke Holzik M, van Heijst AFJ, Bekker MN, Geurtzen R. Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing. BMC Med Inform Decis Mak 2022; 22:7. [PMID: 34991580 PMCID: PMC8734286 DOI: 10.1186/s12911-021-01735-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/14/2021] [Indexed: 01/04/2023] Open
Abstract
Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor.
Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01735-z.
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Affiliation(s)
- Josephus F M van den Heuvel
- Department of Obstetrics, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Margo Lutke Holzik
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands.
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Cavolo A, Dierckx de Casterlé B, Naulaers G, Gastmans C. Neonatologists' Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study. Front Pediatr 2022; 10:852073. [PMID: 35402353 PMCID: PMC8989134 DOI: 10.3389/fped.2022.852073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Deciding whether initiating or withholding resuscitation at birth for extremely preterm infants (EPIs) can be difficult due to uncertainty on outcomes. Clinical uncertainty generates ethical uncertainty. Thus, physicians' attitudes and perspectives on resuscitation of EPIs might influence resuscitation decisions. We aimed at understanding how neonatologists make clinical-ethical decisions for EPI resuscitation and how they perceive these decisions. METHODS We performed a qualitative study using a constructivist account of grounded theory. Face-to-face, semi-structured in-depth interviews with neonatologists comprised data collection. For data analysis, we used the Qualitative Analysis Guide of Leuven. RESULTS We interviewed 20 neonatologists working in 10 hospitals in Belgium. Participants' decision-making can be described as consensus-based, gestational age-based, contextualized, progressive, and shared. All participants agreed on the importance of using the consensus expressed in guidelines as a guidance for the decision-making, i.e., consensus-based. Consequently, all 20 participants use GA thresholds indicated in the guidelines, i.e., GA-based. However, they use these thresholds differently in their decisions. Few participants rigidly follow established thresholds. The vast majority reported using additional contextual factors as birthweight or parents' wishes in the decision-making, rather than only the EPIs' GA, i.e., contextualized. All participants agreed on the importance of involving the parents in the decision-making, i.e., shared, and indeed parents' wishes were among the most valued factors considered in the decision-making. However, the extent to which parents were involved in the decision-making depended on the infant's GA. Participants described a gray zone in which parents' were viewed as the main decision-makers due to the high clinical uncertainty. This mean that participants tend to follow parents' request even when they disagree with it. Outside the gray zone, physicians were viewed as the main decision-makers. This mean that, although parents' wishes were still considered, counseling was more directive and the final decision was made by the physician. CONCLUSION Although an EPI's GA remains the main factor guiding neonatologists' resuscitation decisions, other factors are seriously considered in the decision-making process. All neonatologist participants agreed on the importance of involving parents in the decision-making. However, they involve parents differently depending on the EPI's GA.
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Affiliation(s)
- Alice Cavolo
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | | | - Gunnar Naulaers
- Pregnancy, Fetus and Newborn, Department of Development and Regeneration, UZ Leuven, Leuven, Belgium
| | - Chris Gastmans
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Elternzentrierte ethische Entscheidungsfindung für Frühgeborene im Grenzbereich der Lebensfähigkeit – Reflexion über die Bedeutung probabilistischer Prognosen als Entscheidungsgrundlage. Ethik Med 2021. [DOI: 10.1007/s00481-021-00653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungFrühgeborene im Grenzbereich der Lebensfähigkeit befinden sich in einer prognostischen Grauzone. Das bedeutet, dass deren Prognose zwar schlecht, aber nicht hoffnungslos ist, woraus folgt, dass nach Geburt lebenserhaltende Behandlungen nicht obligatorisch sind. Die Entscheidung für oder gegen lebenserhaltende Maßnahmen ist wertbeladen und für alle Beteiligten enorm herausfordernd. Sie sollte eine zwischen Eltern und Ärzt*innen geteilte Entscheidung sein, wobei sie unbedingt mit den Präferenzen der Eltern abgestimmt sein sollte. Bei der pränatalen Beratung der Eltern legen die behandelnden Ärzt*innen üblicherweise numerische Schätzungen der Prognose vor und nehmen in der Regel an, dass die Eltern ihre Behandlungspräferenzen davon ableiten. Inwieweit probabilistische Daten die Entscheidungen der Eltern in prognostischen Grauzonen tatsächlich beeinflussen, ist noch unzureichend untersucht. In der hier vorliegenden Arbeit wird eine Studie reflektiert, in welcher die Hypothese geprüft wurde, dass numerisch bessere oder schlechtere kindliche Prognosen die Präferenzen werdender Mütter für lebenserhaltende Maßnahmen nicht beeinflussen. In dieser Studie zeigte sich, dass die elterlichen Behandlungspräferenzen eher von individuellen Einstellungen und Werten als von Überlegungen zu numerischen Ergebnisschätzungen herzurühren scheinen. Unser Verständnis, welche Informationen werdende Eltern, die mit einer extremen Frühgeburt konfrontiert sind, wünschen und brauchen, ist noch immer unvollständig. Bedeutende medizinische Entscheidungen werden keineswegs nur rational und prognoseorientiert gefällt. In der vorliegenden Arbeit wird diskutiert, welchen Einfluss der Prozess der Entscheidungsfindung auf das Beratungsergebnis haben kann und welche Implikationen sich aus den bisher vorliegenden Studienergebnissen ergeben – klinisch-praktisch, ethisch und wissenschaftlich.
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Affiliation(s)
- Boris Babic
- Department of Philosophy, The University of Toronto, Toronto, ON, Canada.,Department of Statistical Sciences, The University of Toronto, Toronto, ON, Canada.,INSEAD, Singapore
| | - Sara Gerke
- Penn State Dickinson Law, Carlisle, PA, USA.,The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, The Project on Precision Medicine, Artificial Intelligence, and the Law (PMAIL), Cambridge, MA, USA
| | | | - I Glenn Cohen
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, The Project on Precision Medicine, Artificial Intelligence, and the Law (PMAIL), Cambridge, MA, USA. .,Harvard Law School, Cambridge, MA, USA
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Nayak B, Moon JY, Kim M, Fischhoff B, Haward MF. Optimism bias in understanding neonatal prognoses. J Perinatol 2021; 41:445-452. [PMID: 32778685 DOI: 10.1038/s41372-020-00773-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Discrepancies between physician and parent neonatal prognostic expectations are common. Optimism bias is a possible explanation. STUDY DESIGN Parents interpreted hypothetical neonatal prognoses in an online survey. RESULTS Good prognoses tended to be interpreted accurately, while poor prognoses were interpreted as less than the stated value. One-third of participants consistently overstated survival for the three lowest prognoses, compared to the sample as a whole. Three significant predictors of such optimistic interpretations were single-parent status (OR 0.39; 95% CI 0.2-0.75; p = 0.005), African-American descent (OR 3.78; 95% CI 1.63-8.98; p = 0.002) and the belief that physicians misrepresented prognoses (OR 3.11; 95% CI 1.47-6.65; p = 0.003). Participants' explanations echoed research on optimism bias in clinical and decision science studies. CONCLUSION Participants accepted positive prognoses for critically ill neonates, but reinterpreted negative ones as being unduly pessimistic demonstrating optimism bias.
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Affiliation(s)
- Babina Nayak
- Harlem Hospital Medical Center, Columbia University, New York, NY, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy and Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
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Stanak M. Neonatology in Austria: ethics to improve practice. MEDICINE, HEALTH CARE AND PHILOSOPHY 2020; 23:361-369. [PMID: 32144643 PMCID: PMC7426316 DOI: 10.1007/s11019-020-09943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the world of Austrian neonatal intensive care units, the role of ethics is recognized only partially. The normatively tense cases that are at the backdrop of this essay concern the situations around the limit of viability (weeks 22 + 0 days to 25 + 6 days of gestation), which is the point in the development of an extremely preterm infant at which there are chances of extra-uterine survival. This essay first outlines the key explicit ethical challenges that are mainly concerned with notions of uncertainty and best interest. Then, it attempts to elucidate the less explicit ethical challenges related to the notion of nudging in the neonatal practice and argue that the role of ethics needs to be recognized more—with the focus on the role of virtue ethics—in order to improve the practice of neonatal medicine.
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Cavolo A, Dierckx de Casterlé B, Naulaers G, Gastmans C. Ethics of resuscitation for extremely premature infants: a systematic review of argument-based literature. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106102. [PMID: 32341186 DOI: 10.1136/medethics-2020-106102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/18/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To present (1) the ethical concepts related to the debate on resuscitation of extremely premature infants (EPIs) as they are described in the ethical literature; and (2) the ethical arguments based on these concepts. DESIGN We conducted a systematic review of the ethical literature. We selected articles based on the following predefined inclusion/exclusion criteria: (1) English language articles (2) presenting fully elaborated ethical arguments (3) on resuscitation (4) of EPIs, that is, infants born before 28 weeks of gestation. ANALYSIS After repeated reading of articles, we developed individual summaries, conceptual schemes and an overall conceptual scheme. Ethical arguments and concepts were identified and analysed. RESULTS Forty articles were included out of 4709 screened. Personhood, best interest, autonomy and justice were concepts grounding the various arguments. Regarding these concepts, included authors agreed that the best interest principle should guide resuscitation decisions, whereas justice seemed the least important concept. The arguments addressed two questions: Should we resuscitate EPIs? Who should decide? Included authors agreed that not all EPIs should be resuscitated but disagreed on what criteria should ground this decision. Overall, included authors agreed that both parents and physicians should contribute to the decision. CONCLUSIONS The included publications suggest that while the best interest is the main concept guiding resuscitation decisions, justice is the least important. The included authors also agree that both parents and physicians should be actively involved in resuscitation decisions for EPIs. However, our results suggest that parents' decision should be over-ridden when in contrast with the EPI's best interest.
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Affiliation(s)
- Alice Cavolo
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Gunnar Naulaers
- Pregnancy, Fetus and Newborn, Department of Development and Regeneration, KU Leuven UZ Leuven, Leuven, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
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Tucker Edmonds B, Hoffman SM, Lynch D, Jeffries E, Jenkins K, Wiehe S, Bauer N, Kuppermann M. Creation of a Decision Support Tool for Expectant Parents Facing Threatened Periviable Delivery: Application of a User-Centered Design Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 12:327-337. [PMID: 30488236 DOI: 10.1007/s40271-018-0348-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is optimal in the context of periviable delivery, where the decision to pursue life-support measures or palliation is both preference sensitive and value laden. We sought to develop a decision support tool (DST) prototype to facilitate SDM by utilizing a user-centered design research approach. METHODS We convened four patient and provider advisory boards with women and their partners who had experienced a surviving or non-surviving periviable delivery, pregnant women who had not experienced a prior preterm birth, and obstetric providers. Each 2-h session involved design research activities to generate ideas and facilitate sharing of values, goals, and attitudes. Participant feedback shaped the design of three prototypes (a tablet application, family story videos, and a virtual reality experience) to be tested in a final session. RESULTS Ninety-five individuals (48 mothers/partners; 47 providers) from two hospitals participated. Most participants agreed that the prototypes should include factual, unbiased outcomes and probabilities. Mothers and support partners also desired comprehensive explanations of delivery and care options, while providers wanted a tool to ease communication, help elicit values, and share patient experiences. Participants ultimately favored the tablet application and suggested that it include family testimonial videos. CONCLUSION Our results suggest that a DST that combines unbiased information and understandable outcomes with family testimonials would be meaningful for periviable SDM. User-centered design was found to be a useful method for creating a DST prototype that may lead to improved effectiveness, usability, uptake, and dissemination in the future, by leveraging the expertise of a wide range of stakeholders.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA.
| | - Shelley M Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Dustin Lynch
- Patient Engagement Core, Community Health Partnerships, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Erin Jeffries
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Kelli Jenkins
- Patient Engagement Core, Community Health Partnerships, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Sarah Wiehe
- Patient Engagement Core, Community Health Partnerships, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Nerissa Bauer
- Patient Engagement Core, Community Health Partnerships, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46202, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 550 16th St, Box 0132, San Francisco, CA, 94143, USA
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Moore G, Reszel J, Daboval T, Lemyre B, Barker C, Dunn S. Qualitative evaluation of a guideline supporting shared decision making for extreme preterm birth. J Matern Fetal Neonatal Med 2018; 33:973-981. [PMID: 30107754 DOI: 10.1080/14767058.2018.1512575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background and objectives: The decision to attempt resuscitation or provide palliative care at birth for extremely preterm infants between 22 and 25 weeks remains complex. The purpose of this study was to identify facilitators and barriers to implementation of a clinical practice guideline developed to support shared decision-making for these cases.Methods: A purposeful sample of healthcare providers, involved in the care of one of five cases of anticipated extremely preterm birth, was recruited for interviews. Participants shared their views on the guideline content, implementation process, and facilitators and barriers encountered. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code, categorize, and thematically describe the data. The Knowledge-Attitudes-Behaviours framework was used to organize the findings.Results: Twenty-five key informants (16 physicians, nine nurses) were interviewed. Participants described varying levels of knowledge of the guideline. Facilitators to implementation included: (1) an awareness of, familiarity with and belief in the content; (2) hard copy and electronic guideline accessibility; and, (3) institutional expertise to provide necessary care. Barriers included: (1) minimal awareness or familiarity with the content; (2) lack of agreement with the recommendations; (3) inadequate evidence and applicability to support changes in practice; and, (4) lack of resources to care for the most immature infants.Conclusions: Identified facilitators and barriers will inform the development of tailored strategies for improved local and future broader implementation. Other institutions can use the results to facilitate implementation of their guidelines on this ethically charged area.
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Affiliation(s)
- Gregory Moore
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Obstetrics and Gynecology, Division of Newborn Care, Ottawa Hospital, Ottawa, Canada
| | - Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
| | - Thierry Daboval
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Obstetrics and Gynecology, Division of Newborn Care, Ottawa Hospital, Ottawa, Canada
| | - Brigitte Lemyre
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Obstetrics and Gynecology, Division of Newborn Care, Ottawa Hospital, Ottawa, Canada
| | - Conor Barker
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sandra Dunn
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
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