1
|
Wang D, Li L, Ming BW, Ou CQ, Han T, Cao J, Xie W, Liu C, Feng Z, Li Q. Differences in the attitudes towards resuscitation of extremely premature infants between neonatologists and obstetricians: a survey study in China. Front Pediatr 2023; 11:1308770. [PMID: 38152648 PMCID: PMC10751309 DOI: 10.3389/fped.2023.1308770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Objectives Neonatologists and obstetricians are crucial decision-makers regarding the resuscitation of extremely preterm infants (EPIs). However, there is a scarcity of research regarding the differing perspectives on EPI resuscitation between these medical professionals. We aim to determine the differences and influential factors of their attitudes towards EPIs resuscitation in China. Methods This cross-sectional study was conducted in public hospitals of 31 provinces in Chinese mainland from June to July 2021. Influential factors of binary variables and those of ordinal variables were analyzed by modified Poisson regression models and multinomial logistic regression models due to the invalid parallel line assumption of ordinal logistic regression models. Results A total of 832 neonatologists and 1,478 obstetricians who were deputy chief physicians or chief physicians participated. Compared with obstetricians, neonatologists delivered a larger proportion of infants of <28-week gestational age (87.74% vs. 84.91%) and were inclined to think it inappropriate to use 28 weeks as the cutoff of gestational age for providing full care to premature infants [63.34% vs. 31.60%, adjusted prevalence ratio = 1.61 (95% CI: 1.46-1.77)], and to suggest smaller cutoffs of gestational age and birth weight for providing EPIs resuscitation. Notably, 46.49% of the neonatologists and 19.01% of the obstetricians believed infants ≤24 weeks' gestation should receive resuscitation. Conclusions In China, notable disparities exist in attitudes of neonatologists and obstetricians towards resuscitating EPIs. Strengthening collaboration between these two groups and revising the pertinent guidelines as soon as possible would be instrumental in elevating the resuscitation rate of EPIs.
Collapse
Affiliation(s)
- Dan Wang
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Bo-Wen Ming
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tao Han
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Jingke Cao
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Wenyu Xie
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Changgen Liu
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Zhichun Feng
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Qiuping Li
- Department of Newborn Care Center, Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
- National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| |
Collapse
|
2
|
Geurtzen R, van Heijst A, Draaisma J, Ouwerkerk L, Scheepers H, Hogeveen M, Hermens R. Prenatal counseling in extreme prematurity - Insight into preferences from experienced parents. PATIENT EDUCATION AND COUNSELING 2019; 102:1541-1549. [PMID: 30948203 DOI: 10.1016/j.pec.2019.03.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE In-depth analysis of parental preferences in prenatal counseling in extreme prematurity. METHODS A nationwide qualitative interview study among experienced parents of extremely premature babies born at 24+0/7 - 24+6/7 weeks of gestation. Semi-structured interviews were held until saturation, transcribed and qualitatively analyzed to search for parental counseling preferences. RESULTS Thirteen parents were included, most parents decided on active care. Organisation: Parents wanted counseling as soon as possible, and for various reasons they wanted more than one conversation. Supportive material to help visualize complex information was suggested to be helpful, preferably with adjustable levels of detail. An empathetic, honest style with commitment of the counselor was regarded important. CONTENT Understandable statistics should be used for those who want it. Parents needed different information with respect to the decision-making as opposed to being prepared for future situations. Decision-making: The preferred share of parents' and doctors' input in decision-making varied among parents and among situations. Parents expressed that their roles were to take responsibility for and protect their infant. CONCLUSIONS Various parental preferences for prenatal counseling were found. PRACTICE IMPLICATIONS Common parental preferences for the organisation, content and decision-making elements can provide a starting point for personalized prenatal counseling.
Collapse
Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands.
| | - Arno van Heijst
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Jos Draaisma
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Laura Ouwerkerk
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Marije Hogeveen
- Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, the Netherlands
| |
Collapse
|
3
|
Stanak M, Hawlik K. Decision-making at the limit of viability: the Austrian neonatal choice context. BMC Pediatr 2019; 19:204. [PMID: 31221128 PMCID: PMC6585118 DOI: 10.1186/s12887-019-1569-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to explore the shared decision-making context at the limit of viability (weeks 22-25 of gestation) through analyzing neonatologist's communication strategies with parents and their possible impact on survival and neurodevelopmental impairment (NDI) outcomes. METHODS A mixed methods approach was applied where a systematic literature search and in-depth semi-structured interviews with five heads of neonatology departments and one clinical ethicist from the Austrian context were integrated into a literature review. The aim was to identify decision practice models and the choice context specific to Austria. RESULTS Professional biases, parental understanding, and the process of information giving were identified as aspects possibly influencing survival and NDI outcomes. Institutions create self-fulfilling prophecies by recommending intensive/palliative care based upon their institutional statistics, yet those vary considerably among high-income countries. Labelling an extremely preterm (EP) infant by the gestational week was shown to skew the estimates for survival while the process of information giving was shown to be subject to framing effect and other cognitive biases. CONCLUSION Communication strategies of choice options to parents may have an impact on the way parents decide and hence also on the outcomes of EP infants.
Collapse
Affiliation(s)
- Michal Stanak
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria. .,Department of Philosophy, University of Vienna, Vienna, Austria.
| | - Katharina Hawlik
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| |
Collapse
|
4
|
Geurtzen R, van Heijst AFJ, Draaisma JMT, Kuijpers LJMK, Woiski M, Scheepers HCJ, van Kaam AH, Oudijk MA, Lafeber HN, Bax CJ, Koper JF, Duin LK, van der Hoeven MA, Kornelisse RF, Duvekot JJ, Andriessen P, van Runnard Heimel PJ, van der Heide-Jalving M, Bekker MN, Mulder-de Tollenaer SM, van Eyck J, Eshuis-Peters E, Graatsma M, Hermens RPMG, Hogeveen M. Development of Nationwide Recommendations to Support Prenatal Counseling in Extreme Prematurity. Pediatrics 2019; 143:peds.2018-3253. [PMID: 31160512 DOI: 10.1542/peds.2018-3253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.
Collapse
Affiliation(s)
| | | | | | | | - Mallory Woiski
- Obstetrics and Gynecology, Amalia Children's Hospital and
| | | | | | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center and University of Amsterdam, Amsterdam, Netherlands
| | | | - Caroline J Bax
- Obstetrics and Gynecology, Vrije Universteit Medical Center and Vrije Universteit Amsterdam, Amsterdam, Netherlands
| | | | - Leonie K Duin
- Obstetrics, Gynecology, and Prenatal Diagnosis, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | | | | | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Mireille N Bekker
- Obstetrics and Gynecology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands
| | | | - Jim van Eyck
- Obstetrics and Gynecology, Isala Woman and Children's Hospital Zwolle, Zwolle, Netherlands; and
| | - Ellis Eshuis-Peters
- Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Rosella P M G Hermens
- Scientific Institute for Quality of Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | |
Collapse
|
5
|
Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M. Various experiences and preferences of Dutch parents in prenatal counseling in extreme prematurity. PATIENT EDUCATION AND COUNSELING 2018; 101:2179-2185. [PMID: 30029812 DOI: 10.1016/j.pec.2018.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/28/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate experienced and preferred prenatal counseling among parents of extremely premature babies. METHODS A Dutch nationwide, multicenter, cross-sectional study using an online survey. Surveys were sent to all parents of extremely premature babies born between 2010 and 2013 at 24+0/7-24+6/7 weeks of gestation. RESULTS Sixty-one out of 229 surveys were returned. A minority (14%) had no counseling conversation. Conversations were done more often by neonatologists (90%) than by obstetricians (39%) and in 37% by both these experts. Supportive material was rarely used (19%). Mortality (92%) and short-term morbidity (88%) were discussed the most, and more frequently than long-term morbidity (65%), practical items (63%) and delivery mode (52%). Most decisions on active care or palliative comfort care were perceived as decisions by doctor and parents together (61%). 80% felt they were involved in decision-making. The preferred way of involvement in decision-making varied among parents. CONCLUSION The vast majority of parents were counseled: mostly by neonatologists, and mainly about mortality and short-term morbidity. Parents wanted to be involved in the decision-making process but differed on the preferred extent of involvement. Practice implications Understanding of shared decision-making may contribute to meet the various preferences of parents.
Collapse
Affiliation(s)
- Rosa Geurtzen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands.
| | - Jos Draaisma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
| | - Rosella Hermens
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of IQ Healthcare, Nijmegen, The Netherlands
| | | | - Mallory Woiski
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Gynecology, Nijmegen, The Netherlands
| | - Arno van Heijst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Department of Pediatrics, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Ursin L, Syltern J. In the Best Interest of the. . .Parents: Norwegian Health Personnel on the Proper Role of Parents in Neonatal Decision-making. Pediatrics 2018; 142:S567-S573. [PMID: 30171143 DOI: 10.1542/peds.2018-0478h] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The role of parents in life-and-death decision-making for infants born at the border of viability is challenging. Some argue that parents should have the final say in decisions about life-sustaining treatment. Others disagree. In this article, we report views from health care personnel (HCP) on the appropriate parental role. METHODS Focus group interviews with 5 different groups of HCP (neonatal nurses, midwifes, obstetricians, mother-fetal specialists, and neonatologists) dealing with life-and-death decisions throughout pregnancy and birth were performed at the Norwegian University of Science and Technology and at St Olav's Hospital in Trondheim, Norway in 2014-2017. Interviews were taped and transcribed. Inductive analysis was performed for each group discussion for emergent ethical themes. A summary of the transcribed discussion was sent to the relevant focus group participants for comments. RESULTS Our participants felt strongly that doctors, not parents, should have the final say. They did not think parents should have to live with the burden of the decision. The possible disagreement between parents, lack of necessary knowledge, experience, time, and emotional stability all point toward the neonatologist as the optimal decision-maker, within a model of "Patient Preference-Satisfaction Paternalism." CONCLUSIONS The general attitude of our groups was that parents should have a say and be included in a thorough information and decision-making process. The doctor, or a team of HCP, however, should make the final decision, being in the best position both epistemologically and normatively to promote the best interest of both parents and the child.
Collapse
Affiliation(s)
- Lars Ursin
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; and
| | | |
Collapse
|
7
|
Geurtzen R, Van Heijst A, Hermens R, Scheepers H, Woiski M, Draaisma J, Hogeveen M. Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18:7. [PMID: 29298669 PMCID: PMC5751814 DOI: 10.1186/s12884-017-1644-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/21/2017] [Indexed: 01/10/2023] Open
Abstract
Background Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Methods Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. Results One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Conclusions Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework. Trial registration Clinicaltrials.gov, NCT02782650, retrospectively registered May 2016. Electronic supplementary material The online version of this article (10.1186/s12884-017-1644-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- R Geurtzen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - Arno Van Heijst
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Mallory Woiski
- Amalia Children's Hospital, Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Draaisma
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Amalia Children's Hospital, Department of Pediatrics, Radboud university Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Haward MF, Gaucher N, Payot A, Robson K, Janvier A. Personalized Decision Making: Practical Recommendations for Antenatal Counseling for Fragile Neonates. Clin Perinatol 2017; 44:429-445. [PMID: 28477670 DOI: 10.1016/j.clp.2017.01.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child.
Collapse
Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY 10467, USA
| | - Nathalie Gaucher
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada
| | - Antoine Payot
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada
| | - Kate Robson
- Canadian Premature Babies Foundation, Toronto, Ontario M4N 3M5, Canada
| | - Annie Janvier
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Department of Pediatrics and Clinical Ethics, Sainte-Justine Hospital, University of Montreal, 3175 Chemin Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| |
Collapse
|
9
|
Geurtzen R, van Heijst A, Draaisma J, Ouwerkerk L, Scheepers H, Woiski M, Hermens R, Hogeveen M. Professionals' preferences in prenatal counseling at the limits of viability: a nationwide qualitative Dutch study. Eur J Pediatr 2017; 176:1107-1119. [PMID: 28687856 PMCID: PMC5511326 DOI: 10.1007/s00431-017-2952-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/27/2022]
Abstract
UNLABELLED Prenatal counseling practices at the limits of viability do vary, and constructing a counseling framework based on guidelines, professional and parental preferences, might achieve more homogeneity. We aimed to gain insight into professionals' preferences on three domains of counseling, particularly content, organization, and decision making and their influencing factors. A qualitative, nationwide in-depth exploration among Dutch perinatal professionals by semi-structured interviews in focus groups was performed. Regarding content of prenatal counseling, preparing parents on the short-term situation (delivery room care) and revealing their perspectives on "quality of life" were considered important. Parents should be informed on the kind of decision, on the difficulty of individual outcome predictions, on survival and mortality figures, short- and long-term morbidity, and the burden of hospitalization. For organization, the making of and compliance with agreements between professionals may promote joint counseling by neonatologists and obstetricians. Supportive materials were considered useful but only when up-to-date, in addition to the discussion and with opportunity for personalization. Regarding decision making, it is not always clear to parents that a prenatal decision needs to be made and they can participate, influencing factors could be, e.g., unclear language, directive counseling, overload of information, and an immediate delivery. There is limited familiarity with shared decision making although it is the preferred model. CONCLUSION This study gained insight into preferred content, organization, and decision making of prenatal counseling at the limits of viability and their influencing factors from a professionals' perspective. What is Known: • Heterogeneity in prenatal counseling at the limits of viability exists • Differences between preferred counseling and actual practice also exists What is New: • Insight into preferred content, organization, and decision making of prenatal periviability counseling and its influencing factors from a professionals' perspective. Results should be taken into account when performing counseling. • Particularly the understanding of true shared decision making needs to be improved. Furthermore, implementation of shared decision making in daily practice needs more attention.
Collapse
Affiliation(s)
- Rosa Geurtzen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, PO Box 9101, 6500HB, Nijmegen, Internal Code 804, The Netherlands.
| | - Arno van Heijst
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | - Jos Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | - Laura Ouwerkerk
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| | | | - Mallory Woiski
- Department of Gynecology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, PO Box 9101, 6500HB Nijmegen, Internal Code 804, The Netherlands
| |
Collapse
|
10
|
Perinatal practice in extreme premature delivery: variation in Dutch physicians' preferences despite guideline. Eur J Pediatr 2016; 175:1039-46. [PMID: 27251669 PMCID: PMC4930484 DOI: 10.1007/s00431-016-2741-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/19/2016] [Accepted: 05/25/2016] [Indexed: 11/04/2022]
Abstract
UNLABELLED Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians' preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24(+0/7) weeks of gestational age (GA). Obstetricians' and neonatologists' opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24(+0/7) weeks and intensive care over 26(+0/7) weeks. The professional views varied most at 24 and 25 weeks, with intensive care recommended but comfort care at parental request optional being the median. There was a wide range in perceived lowest limits of GA for interventions as a caesarian section and a neonatologist present at birth. Obstetricians and neonatologists disagreed on the lowest limit providing chest compressions and administering epinephrine for resuscitation. The main factors restricting active treatment were presence of congenital disorders, "small for gestational age" fetus, and incomplete course of corticosteroids. CONCLUSION There was a wide variety in individually preferred treatment decisions, especially when aspects were not covered in the Dutch guideline on perinatal practice in extreme prematurity. Furthermore, obstetricians and neonatologists did not always agree. WHAT IS KNOWN • Cross-cultural differences exists in the preferred treatment at the limits of viability • In the Netherlands since 2010, intensive care can be offered starting at 24 (+0/7) weeks gestation What is new: • There was a wide variety in preferred treatment decisions at the limits of viability especially when aspects were not covered in the Dutch national guideline on perinatal practice in extreme prematurity.
Collapse
|