Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study (original) (raw)
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Comparing obstetricians' and neonatologists' approaches to periviable counseling
Journal of perinatology : official journal of the California Perinatal Association, 2014
Objective:To compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling.Study Design:Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes.Result:Obstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort o...
Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling: In Reply
PEDIATRICS, 2005
Objectives. To determine the accuracy of knowledge of different health care providers regarding survival and long-term morbidity rates for very premature infants and to examine whether a focused educational intervention improves the accuracy of this knowledge and influences health care decisions. Methods. Using hypothetical case scenarios with infants at <28 weeks of gestation, we surveyed a variety of caregivers involved in perinatal communication and decision-making processes at a tertiary center that provides intensive care for neonates. We asked physicians from the pediatrics and obstetrics services and nurses and nurse practitioners from the NICU and obstetrics ward for their best estimates of survival and major long-term disability rates and for their opinions regarding the appropriateness of resuscitation and life support at each week of gestation of <29 weeks. After the survey, we educated all providers about current data on survival and long-term disability rates for preterm infants and gave them pocket-sized cards summarizing this information for reference during prenatal counseling. One month after the educational intervention and complete dissemination of the cards, a questionnaire with questions identical to those in the first survey was mailed to the same individuals. Results. Fifty-one health care providers were involved in the baseline survey. The response rates for the postintervention survey were 100% for physicians (20 of 20 subjects) and nurses (20 of 20 subjects) and 91% (10 of 11 subjects) for the nurse practitioners. In the baseline survey, statistically significant underestimates of survival rates were seen for physicians and nurses at 23 to 28 weeks of gestation and for nurse practitioners at 23 to 27 weeks of gestation. Statistically significant overestimates of disability rates were seen for physicians and nurse practitioners at <26 weeks of gestation and for nurses at <28 weeks of gestation. After the intervention, respondents demonstrated significant improvements in the accuracy of survival and disability estimates at many, but not all, gestational ages. Although underestimation of survival rates and overestimation of disability rates decreased after the intervention, it persisted to some degree. After the intervention, a larger proportion of physicians (53% vs 21%) and a smaller proportion of nurses (10% vs 37%) were likely to recommend resuscitation for infants born at 23 weeks of gestation. Conclusions. Physicians, nurses, and nurse practitioners underestimated survival rates and overestimated long-term disability rates for very premature infants. After education, their estimates of survival and long-term disability rates for these infants improved significantly. More accurate estimates of survival and disability rates affected physicians' and nurses' theoretical decisionmaking regarding the appropriateness of resuscitation at 23 weeks of gestation.
Communication and Decision Making in Neonatal Intensive Care: Why Narrative Medicine Matters
2020
Objective: This paper aims to analyse parents’ and health professionals’ discourse, regarding four main areas: (1) the experience of care; (2) communication among all stakeholders; (3) ethical issues; (4) and ethical decision-making. Methodology: The authors collected 62 narratives from health professionals and parents whose newborns have been hospitalized for at least 15 days in the neonatal intensive care unit (NICU). We carried out a qualitative content analysis with the support of NVivo software version 12 Pro. Results: The feelings/emotions are present in a high percentage of narratives (mostly negative ones). Parents´ learning emphasizes coping strategies. Most narratives focus on communicational aspects. Decision-making is referred to in almost half of the narratives. The ethical issues and questions mentioned are mainly related to decision-making. Conclusion: The present study emphasizes narrative relevance in the alignment of parents´ and health professionals´ perspectives ...
Characterising doctor-parent communication in counselling for impending preterm delivery
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2002
To examine the counselling of women admitted to hospital in preterm labour. Such women and their partners are often asked to participate in difficult decisions including mode of delivery, fetal monitoring, and resuscitation. Questionnaire based descriptive study. A tertiary level perinatal referral centre. Forty-nine women in preterm labour at 22-30 weeks gestation, admitted in two separate periods between March 1997 and May 1999. INTERVENTION AND OUTCOME MEASURE: Within 24 hours of counselling, parents were asked to complete a questionnaire assessing recall of the management plan, desire for involvement in decision making, anxiety, and feelings of control over their health. A parallel questionnaire was completed by the clinicians. Parents and clinicians on recall agreed well about obstetric issues but poorly about neonatal issues. Overall 27% of parents felt: "I would prefer to have the doctors advise me, rather than asking me to decide". In 79% of cases, clinicians believed parents preferred advice rather than to make decisions, but in 45% of these, they misidentified those who wished to make their decisions. Anxiety levels for one third of the mothers were high, and associated with poorer concordance of recall between parents and clinicians. Serious deficiencies exist in parent-clinician encounters during extremely preterm labour. Concordance between parents and clinicians is poor and anxiety very high. A quarter of parents appear to prefer to relinquish decision making autonomy, but clinicians cannot correctly identify this subgroup. Standardised counselling in the perinatal period, using formal decision aids, should be investigated.
2004
Neonatology is a branch of paediatrics dealing with extremely ill or premature babies, and the neonatal intensive care unit (NICU) is frequently the setting for life-and-death decisions. Society considers parents to be the proper persons to make those decisions for their babies, but in practice they seem to be allowed to do this only as long as they agree with medical recommendations; otherwise, the "best interest standard" is proposed. My objective is to evaluate decision-making in the NICU. Part I of this research, a descriptive study, compares decision-making by parents, doctors, and nurses when presented with hypothetical scenarios. Part II, through in-depth interviews, evaluates factors important to parents in making life-anddeath decisions. Part III, using structured interviews, explores the neonatologists' perceptions of the limits of parental decision-making authority. The results reveal that parents make different decisions from those of doctors and nurses. Parents have an equal commitment to intensive care (35-40%) with either mental or physical handicap. Doctors and nurses, on the other hand, have less commitment to intensive care with severe mental handicap (10%), but more commitment with physical handicap (90%). Religious commitment and experience with handicap influence decisions by parents, but not by doctors and nurses. The right of parents to decide for their baby and the interests of the family are also more important for parents than for doctors and nurses. For parents, furthermore, the important factors are an honest, caring, transparent relationship with good communication with their neonatologist; being fully informed; their values and beliefs; their roles and their sense of loss of control; and emotional turmoil. Of these interrelated factors, the most important is the relationship between CHAPTER II Body of Thesis: Methodology and Results 2.
Journal of Perinatal & Neonatal Nursing, 2011
Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being.
Effective nurse parent communication: A study of parents’ perceptions in the NICU environment
Patient Education and Counseling, 2007
Objective: This study examined mothers' and fathers' perceptions of effective and ineffective communication by nurses in the Neonatal Intensive Care Unit (NICU) environment, using Communication Accommodation Theory (CAT) as the framework. Methods: 20 mothers and 13 fathers participated in a semi-structured interview about their perceptions of effective and ineffective communication with nurses when their infant was in the NICU. The interviews were coded for using the CAT strategies. Results: Descriptions of effective and ineffective communication differed in terms of the strategies mentioned with effective communication about shared management of the interaction and appropriate support and reassurance by nurses. Ineffective communication was more about the interpretability strategy, particularly for fathers, and these interactions were seen as more intergroup. Mothers emphasised more being encouraged as equal partners in the care of their infant.
Parental involvement in neonatal critical care decision-making
The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: 'making recommendations' and 'providing options'. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. 'Making recommendations' led to misalignment and reduced opportunities for questions and collaboration; 'providing options' led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch? v=MyuymxDNupk&feature=youtu.be
How doctors communicated with parents in a neonatal intensive care: Communication and ethical issues
Acta Paediatrica, 2020
AimDoctors have a moral and legal obligation to keep patients and their families informed, and this is an integral part of care. We explored the communication strategies used by doctors when they spoke to parents in a French neonatal intensive care unit (NICU).MethodsThis was a single‐centre qualitative pilot study carried out from October 2015 to January 2016. We asked five doctors (three female) to audiotape their discussions with the parents of newborn infants during their NICU stay. The doctors’ mean age was 43 years, and they had a mean of 14 years of NICU experience. Each discussion was subjected to thematic content analysis.ResultsWe analysed 40 discussions carried out between doctors on 26 newborn infants. Five communication strategy themes emerged: building understanding, how the communication was constructed, the role of the doctor, and of the parents, in the overall care of the newborn infant and how the information given to the parents developed over time.ConclusionAnaly...