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Am J Perinatol 2024; 41(06): 713-721
DOI: 10.1055/s-0041-1742186
Original Article

How do Clinicians View the Process of Shared Decision-Making with Parents Facing Extremely Early Deliveries? Results from an Online Survey

Brennan Hodgson Kim‡   *
1   Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Jeanne Krick‡   *
2   Department of Pediatrics, San Antonio Military Medical Center, San Antonio, Texas
,
Simone Schneider
3   Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Andres Montes
4   Department of Obstetrics and Gynecology, St. Joseph's/Candler Health System, Savannah, Georgia
,
Uchenna E. Anani 
5   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
,
Peter D. Murray
6   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
,
Marin Arnolds
7   Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
,
Dalia M. Feltman 
8   Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
9   Pritzker School of Medicine, University of Chicago, Chicago, Illinois
› Institutsangaben Funding Data management was possible through grant support for REDCap from NorthShore University HealthSystem.
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Abstract

Objective The objective of this study was to better understand how neonatology (Neo) and maternal–fetal medicine (MFM) physicians approach the process of shared decision-making (SDM) with parents facing extremely premature (<25 weeks estimated gestational age) delivery during antenatal counseling.

Study Design Attending physicians at U.S. centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. Preferences for conveying information are reported elsewhere. Here, we report clinicians' self-assessments of their ability to engage in deliberations and decision-making and perceptions of what is important to parents in the SDM process. Multivariable logistic regression analyzed respondents' views with respect to individual characteristics, such as specialty, gender, and years of clinical experience.

Results In total, 74 MFMs and 167 Neos representing 94% of the 81 centers surveyed responded. Neos versus MFMs reported repeat visits with parents less often (<0.001) and agreed that parents were more likely to have made delivery room decisions before they counseled them less often (p < 0.001). Respondents reported regularly achieving most goals of SDM, with the exception of providing spiritual support. Most respondents reported that spiritual and religious views, risk to an infant's survival, and the infant's quality of life were important to parental decision-making, while a physician's own personal choice and family political views were reported as less important. While many barriers to SDM exist, respondents rated language barriers and family views that differ from those of a provider as the most difficult barriers to overcome.

Conclusion This study provides insights into how consultants from different specialties and demographic groups facilitate SDM, thereby informing future efforts for improving counseling and engaging in SDM with parents facing extremely early deliveries and supporting evidence-based training for these complex communication skills.

Key Points

  • Perceptions differed by specialty and demographics.

  • Parents' spiritual needs were infrequently met.

  • Barriers to shared decision-making exist.

Keywords

antenatal counseling - decision-making - extreme prematurity - maternal–fetal medicine - neonatology - ethical barriers - resuscitation

* These authors contributed equally to this work.




Publikationsverlauf

Eingereicht: 02. August 2021

Angenommen: 09. Dezember 2021

Artikel online veröffentlicht:
11. Januar 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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