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Periviability Decision-Making: Assessing Provider Characteristics and Cognitive Traits.

Ariel Sklar1,2, Amy Yang3, Noelle G Martinez1

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Women'S Health Reports (New Rochelle, N.Y.)
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Summary

Maternal-fetal medicine physicians' periviable delivery management approaches varied by personal factors, not overall cognitive traits. However, stronger coping skills were linked to recommending termination at 21 weeks.

Keywords:
decision-makingperiviabilityphysician cognitive skillsphysician coping

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Area of Science:

  • Perinatal Medicine
  • Medical Decision-Making
  • Physician Behavior

Background:

  • Periviable delivery management involves complex decisions with significant ethical considerations.
  • Understanding factors influencing maternal-fetal medicine (MFM) physician recommendations is crucial for standardized care.
  • Previous research has not fully explored the impact of physician characteristics on these critical decisions.

Purpose of the Study:

  • To investigate MFM physicians' approaches to periviable delivery management.
  • To examine associations between personal characteristics, practice features, cognitive traits, and these approaches.
  • To identify potential influences on recommendations, particularly at points of clinical equipoise.

Main Methods:

  • Cross-sectional survey study of Society for Maternal-Fetal Medicine members.
  • Eight clinical scenarios presented to assess "willingness to intervene" and "willingness to recommend termination" scores.
  • Bivariable and multivariable analyses used to assess associations with provider characteristics and cognitive traits.

Main Results:

  • Willingness to recommend termination correlated with less willingness to consider cerclage and specific geographic regions.
  • Overall cognitive scores were not associated with management recommendations.
  • At 21 weeks, higher coping skills were associated with a greater likelihood of recommending termination, even after controlling for region.

Conclusions:

  • MFM physician recommendations for periviable delivery are influenced by personal and practice characteristics, not overall cognitive traits.
  • Cognitive traits, such as coping skills, may play a role in recommendations at critical gestational ages with clinical equipoise.
  • Further research is needed to explore these associations in a larger cohort.