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How do Clinicians View the Process of Shared Decision-Making with Parents Facing Extremely Early Deliveries? Results
Brennan Hodgson Kim1, Jeanne Krick2, Simone Schneider3
1Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois.
Insights
Neonatologists and maternal-fetal medicine specialists differ in shared decision-making (SDM) approaches for parents of extremely premature infants. While most SDM goals are met, spiritual support and language barriers pose challenges.
Area of Science:
- Perinatal medicine
- Neonatal care
- Medical ethics
Background:
- Shared decision-making (SDM) is crucial in antenatal counseling for extremely premature births (<25 weeks).
- Understanding physician approaches to SDM is vital for improving patient-centered care.
Purpose of the Study:
- To investigate how neonatology (Neo) and maternal-fetal medicine (MFM) physicians conduct SDM with parents during antenatal counseling for extremely premature deliveries.
- To compare the perceptions and practices of Neo and MFM physicians regarding SDM.
Main Methods:
- An online survey was administered to attending physicians at U.S. centers with Neo and MFM fellowships.
- The survey assessed clinicians' self-reported ability to engage in SDM and their perceptions of parental priorities.
- Multivariable logistic regression analyzed factors influencing respondents' views.
Main Results:
- Responses from 74 MFMs and 167 Neos indicated differences in practice, with Neos reporting fewer repeat visits and less frequent parental delivery room decisions prior to counseling.
- Most physicians felt they achieved SDM goals, except for providing spiritual support.
- Physicians identified spiritual/religious views, infant survival risk, and quality of life as important to parents, while personal/family political views were less so.
- Language barriers and differing family views were perceived as the most significant barriers to SDM.
Conclusions:
- Physician perceptions and practices in SDM vary by specialty and demographics.
- There is a need to improve the provision of spiritual support during antenatal counseling.
- Addressing barriers such as language and differing family values is essential for effective SDM.
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..
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