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Navigating birth plans: illuminating neonatal provider perspectives in prenatally diagnosed complex fetal anomalies
Daniel Kadden1,2, Samantha Palmaccio-Lawton3,4,5,6, Lisa E Herrmann4,7
1Department of Anesthesia Critical Care Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. dkadden@chla.usc.edu.
Insights
Neonatal providers show varied interpretations of birth plans for complex conditions. These plans are best used for family discussions, not strict care directives.
Area of Science:
- Neonatal Medicine
- Palliative Care
- Medical Ethics
Background:
- Birth plans outline neonatal care preferences for complex prenatal diagnoses.
- Understanding provider interpretation is crucial for effective implementation.
Purpose of the Study:
- To assess how neonatal providers interpret birth plans for fetuses with prenatally diagnosed life-limiting conditions.
- To identify factors influencing the interpretation of these critical documents.
Main Methods:
- A single-site study surveyed neonatal providers using three case scenarios.
- Provider responses regarding care limitations were analyzed using descriptive statistics and Chi-square/Fisher's exact tests.
Main Results:
- A significant variability in provider responses and proposed interventions was observed.
- Prior palliative care training did not substantially alter birth plan interpretation.
Conclusions:
- The variability in interpretation highlights birth plans' role in facilitating family discussions.
- Birth plans serve as guides for conversations, not prescriptive care protocols.
Background/Objectives:
Birth plans include preferences for neonatal care in prenatally diagnosed complex medical conditions. This study aimed to determine how neonatal providers interpret birth plans for those with prenatally diagnosed life-limiting conditions.
Subjects/Methods:
This single-site study of neonatal attendings, fellows, advance practice providers, and pediatricians assessed provider actions to prompts associated with potential limitations of care identified in birth plans via three case scenarios developed by palliative care and neonatal providers, with expert review. Data analysis included descriptive statistics and Chi-square or Fisher's exact test, to assess associations between responses and demographics.
Results:
Seventy-five providers completed the survey (54% response rate). We identified high degree of variability in responses, including high-risk interventions. Previous palliative care training had little impact on interpretation of birth plans.
Conclusion:
High degrees of variability in birth plan interpretation supports their utility to guide discussion with families, rather than a step-by-step guide for care.
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