What Information Do Clinicians Deem Important for Counseling Parents Facing Extremely Early Deliveries?: Results from an Online Survey

Brennan Hodgson Kim; Dalia M. Feltman; Simone Schneider; Constance Herron; Andres Montes; Uchenna E. Anani; Peter D. Murray; Marin Arnolds; Jeanne Krick

doi:10.1055/s-0041-1730430

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(06): 657-665
DOI: 10.1055/s-0041-1730430

Original Article

What Information Do Clinicians Deem Important for Counseling Parents Facing Extremely Early Deliveries?: Results from an Online Survey

Brennan Hodgson Kim‡^*

¹Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois

,

Dalia M. Feltman ‡^*

²Department of Pediatrics, NorthShore University HealthSystem Evanston Hospital, Evanston, Illinois

,

Simone Schneider

³Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois

⁴Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Constance Herron

⁵Graduate Student Intern, School of Health Studies, Northern Illinois University, DeKalb, Illinois

,

Andres Montes

⁶Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia

,

Uchenna E. Anani

⁷Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

,

Peter D. Murray

⁸Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia

,

Marin Arnolds

²Department of Pediatrics, NorthShore University HealthSystem Evanston Hospital, Evanston, Illinois

³Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois

,

Jeanne Krick

⁹Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington

› Author Affiliations

Abstract

Objective The study aimed to better understand how neonatology and maternal fetal medicine (MFM) physicians convey information during antenatal counseling that requires facilitating shared decision-making with parents facing options of resuscitation versus comfort care after extremely early delivery

Study Design Attending physicians at US centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. The survey assessed information conveyed, processes for facilitating shared decision-making (reported separately), and clinical experiences. Neonatology and MFM responses were compared. Multivariable logistic regression analyzed topics often and seldom discussed by specialty groups with respect to respondents' clinical experience and resuscitation option preferences at different gestational weeks.

Results In total, 74 MFM and 167 neonatologists representing 94% of the 81 centers surveyed responded. Grouped by specialty, respondents were similar in counseling experience and distribution of allowing choices between resuscitation and no resuscitation for delivery at specific weeks of gestational ages. MFM versus neonatology reported similar rates of discussing long-term health and developmental concerns and differed in all other categories of topics. Neonatologists were less likely than MFM to discuss caregiver impacts (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.11–0.18, p < 0.001) and comfort care details (OR: 0.19, 95% CI: 0.15–0.25, p < 0.001). Conversely, neonatology versus MFM respondents more frequently reported “usually” discussing topics pertaining to parenting in the NICU (OR: 1.5, 95% CI: 1.2–1.8, p < 0.001) and those regarding stabilizing interventions in the delivery room (OR: 1.8, 95% CI: 1.4–2.2, p < 0.001). Compared with less-experienced respondents, those with 17 years' or more of clinical experience had greater likelihood in both specialties to say they “usually” discussed otherwise infrequently reported topics pertaining to caregiver impacts.

Conclusion Parents require information to make difficult decisions for their extremely early newborns. Our findings endorse the value of co-consultation by MFM and neonatology clinicians and of trainee education on antenatal consultation education to support these families.

Key Points

Neonatology versus MFM counselors provide complementary information.
More experience was linked to discussing some topics.
Co-consultation and trainee education is supported.
What information parents value requires study.

Keywords

periviable - antenatal counseling - decision-making - extreme prematurity - neonatal resuscitation - ethics - maternal fetal medicine - neonatology - physician attitudes

Full Text

References

References
1 Cummings J. Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics 2015; 136 (03) 588-595
2 Raju TNK, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34 (05) 333-342
3 Lemyre B, Daboval T, Dunn S. et al. Shared decision making for infants born at the threshold of viability: a prognosis-based guideline. J Perinatol 2016; 36 (07) 503-509
4 Boss RD, Hutton N, Sulpar LJ, West AM, Donohue PK. Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns. Pediatrics 2008; 122 (03) 583-589
5 Janvier A, Farlow B, Baardsnes J, Pearce R, Barrington KJ. Measuring and communicating meaningful outcomes in neonatology: a family perspective. Semin Perinatol 2016; 40 (08) 571-577
6 Guillén Ú, Mackley A, Laventhal N. et al. Evaluating the use of a decision aid for parents facing extremely premature delivery: a randomized trial. J Pediatr 2019; 209: 52-60.e1
7 Geurtzen R, Van Heijst A, Hermens R. et al. Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals. BMC Pregnancy Childbirth 2018; 18 (01) 7
8 Gaucher N, Nadeau S, Barbier A, Janvier A, Payot A. Personalized antenatal consultations for preterm labor: responding to mothers' expectations. J Pediatr 2016; 178: 130-134.e7
9 Haward MF, Kirshenbaum NW, Campbell DE. Care at the edge of viability: medical and ethical issues. Clin Perinatol 2011; 38 (03) 471-492
10 Gaucher N, Payot A. Focusing on relationships, not information, respects autonomy during antenatal consultations. Acta Paediatr 2017; 106 (01) 14-20
11 Elwyn G, Frosch D, Thomson R. et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27 (10) 1361-1367
12 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
13 Ramsay SM, Santella RM. The definition of life: a survey of obstetricians and neonatologists in New York City hospitals regarding extremely premature births. Matern Child Health J 2011; 15 (04) 446-452
14 Tucker Edmonds B, McKenzie F, Panoch JE, Barnato AE, Frankel RM. Comparing obstetricians' and neonatologists' approaches to periviable counseling. J Perinatol 2015; 35 (05) 344-348
15 Arzuaga BH, Cummings CL. Practices and education surrounding anticipated periviable deliveries among neonatal-perinatal medicine and maternal-fetal medicine fellowship programs. J Perinatol 2016; 36 (09) 699-703
16 Lawrence C, Laventhal N, Fritz KA. et al. Ethical cultures in perinatal care: do they exist? correlation of provider attitudes with periviability practices at six centers. Am J Perinatol 2021; 38 (S01): e193-e200
17 Feltman DM, Williams DD, Carter BS. How are neonatology fellows trained for antenatal periviability counseling?. Am J Perinatol 2017; 34 (13) 1279-1285
18 Arbour K, Lindsay E, Laventhal N. et al. Shifting provider attitudes and institutional resources surrounding resuscitation at the limit of gestational viability. Am J Perinatol 2022; 39 (08) 869-877
19 Feltman DM, Fritz KA, Datta A. et al. Antenatal periviability counseling and decision making: a retrospective examination by the investigating neonatal decisions for extremely early deliveries study group. Am J Perinatol 2020; 37 (02) 184-195
20 Rysavy MA, Li L, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
21 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
22 Bastek TK, Richardson DK, Zupancic JAF, Burns JP. Prenatal consultation practices at the border of viability: a regional survey. Pediatrics 2005; 116 (02) 407-413
23 Carter BS. More than medication: perinatal palliative care. Acta Paediatr 2016; 105 (11) 1255-1256
24 Arnold L, Sawyer A, Rabe H. et al; ‘Very Preterm Birth Qualitative Collaborative Group’. Parents' first moments with their very preterm babies: a qualitative study. BMJ Open 2013; 3 (04) e002487

Supplementary Material

Supplementary Material