End-of-life decisions in perinatal care. A view from health-care providers

Grether, Patricia; Lisker, R; Lorı́a, Alvar; Álvarez-del-Río, Asunción

doi:10.21149/spm.v57i6.7637

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…This article is protected by copyright. All rights reserved decision (24), or TOP indication (19,20,22,23,(25)(26)(27) and usually indicate large differences between study groups. Insight into attitudes of other healthcare professionals involve in late TOP decision-making and counselling, combined with personal influencing factors and a more detailed investigation according to severity or specific case, is lacking.…”

Section: Accepted Articlementioning

confidence: 99%

Healthcare Professionals' Attitudes towards Termination of Pregnancy at Viable Stage

Roets¹

2019

Preprint

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Introduction: Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes when the foetus is already viable (late TOP). This study aims to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice. Material and methods: Mail survey among all physicians and paramedical professionals involved in late TOP decision-making in all eight centres with a Neonatal Intensive Care Unit in Flanders, Belgium (N=117). The questionnaire contained general and case-based attitude items.Results: Response rate was 79%. Respondents were either physicians (51,1%) or paramedical professionals (49,9%). The composition of professionals involved in late TOP decision-making was very heterogeneous between the eight centres. Late TOP is highly accepted in both lethal foetal conditions (100%) and serious (but not lethal) foetal conditions (95.6%). Where the foetus is healthy, 19.8% of respondents agrees with late TOP for maternal psychological problems and fewer respondents (13.2%) agree with late TOP in case of maternal socio-economic problems (p=0.002). Physicians more often prefer foeticide over neonatal palliative care in case of nonlethal foetal conditions compared to paramedical professionals (68.1% vs 53.2%, p=0.013).Almost nine out of ten respondents (89.1%) agree that in the event of a serious (non-lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life is acceptable. Behavioural intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP. Conclusions:Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are in demand of legislative change regarding active life-ending in the foetal and neonatal period. Further research should explore correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.

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Section: Accepted Articlementioning

confidence: 99%

Healthcare Professionals' Attitudes towards Termination of Pregnancy at Viable Stage

Roets¹

2019

Preprint

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“…Moreover, due to differences in national legislations, international uniformity (of consensus) is difficult to reach. [3][4][5] Internationally, legislation on TOP varies strongly, [6][7][8][9] ranging from completely legal for any type of abortion regardless of pregnancy duration to TOP being allowed depending on certain preconditions such as pregnancy duration and presence of lethal foetal anomalies. 10 The Belgian abortion law is summarised in Box 1.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy termination at a viable stage in daily clinical practice: A nationwide mortality follow‐back study in Flanders, Belgium

et al. 2023

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Objective: Congenital malformations are frequently diagnosed prenatally even at a viable stage. No adequate registration of incidence and characteristics of late termination of pregnancy (TOP) or abortion for medical reasons exists in Flanders. Methods: Nationwide mortality follow-back survey sent to physicians signing death certificates of all stillbirths for 22 weeks gestation onward (September 2016-December 2017) in Flanders, Belgium. Questions measured whether late TOP preceded stillbirth, and which clinical and sociodemographic characteristics were indicated. Questionnaire data were linked with sociodemographic information from death certificates. Results: Response rate was 56% (203/366). 38% of stillbirths (77/203) concerned late TOP. In 88.3% of late TOPs, physicians classified congenital anomalies of the foetus as serious or very serious (incompatibility with life outside the womb or severe neurological or physical impairment). In 26% of cases, late TOP was first suggested by the physician rather than spontaneously requested by parents (73%). 88% of late TOPs were discussed in open team meetings. Conclusions: 2/5 stillbirths were preceded by late TOP, indicating severe underreportation by existing registrations and a dire need for adequate registration methods. Although late TOP was most often explicitly requested by parents, in ¼ cases termination was suggested first by physicians. Parents are sometimes hesitant to bring up late TOP themselves, indicating that TOP should always be counselled as an equivalent option. Key pointsWhat is already known about this topic? � Congenital malformations are more frequently diagnosed prenatally, possibly at a viable stage. This may lead to decisions resulting in the (late) termination of pregnancy (late TOP).� No adequate registration of incidence, indication, the decision-making process and medical acts of late TOP on the population level in Flanders exists.Ellen Roets and Kim Beernaert contributed equally to this work. Kristien Roelens and Laure Dombrecht contributed equally to this work.

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“…[13][14][15][16][17] Previous studies showed that attitudes of healthcare providers towards TOP are influenced by personal obstetric history, 18 professional experience, [18][19][20] religious beliefs [18][19][20] and professional orientation, [20][21][22][23] eg maternal-fetal medicine specialists vs neonatal specialists, or doctors vs nurses. These studies are limited to studying physicians' or nurses' attitudes towards late TOP, or compare only one aspect, such as demographic factors, [18][19][20][21][22][23] the type of end-of life decision, 24 or TOP indication 19,20,22,23,[25][26][27] and usually indicate large differences between study groups. Insight into attitudes of other healthcare professionals involved in late TOP decision-making and counseling, combined with personal influencing factors and a more detailed investigation according to severity or specific case, is lacking.…”

Section: Introductionmentioning

confidence: 99%

Healthcare professionals’ attitudes towards termination of pregnancy at viable stage

Roets

Dierickx

Deliëns

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes at a gestational age when the fetus is already viable (late TOP). We aimed to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice. Material and methods A mail survey was conducted among all physicians and paramedical professionals involved in late TOP decision‐making in all eight centers with a Neonatal Intensive Care Unit in Flanders, Belgium (N = 117). The questionnaire contained general and case‐based attitude items. Results Response rate was 79%. Respondents were either physicians (51.1%) or paramedical professionals (49.9%). The composition of professionals involved in late TOP decision‐making was heterogeneous between the eight centers. Late TOP was highly accepted in both lethal fetal conditions (100%) and serious (but not lethal) fetal conditions (95.6%). Where the fetus is healthy, 19.8% of respondents agreed with late TOP for maternal psychological problems and fewer respondents (13.2%) agreed with late TOP in the case of maternal socio‐economic problems (P = .002). Physicians more often preferred feticide over neonatal palliative care in the case of non‐lethal fetal conditions compared with paramedical professionals (68.1% vs 53.2%, P = .013). Almost nine out of ten respondents (89.1%) agreed that in the event of a serious (non‐lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life was acceptable. Behavioral intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP. Conclusions Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are demanding legislative change regarding active life‐ending in the fetal and neonatal periods. Further research should explore the correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.

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End-of-life decisions in perinatal care. A view from health-care providers

Cited by 3 publications

References 16 publications

Healthcare Professionals' Attitudes towards Termination of Pregnancy at Viable Stage

Healthcare Professionals' Attitudes towards Termination of Pregnancy at Viable Stage

Pregnancy termination at a viable stage in daily clinical practice: A nationwide mortality follow‐back study in Flanders, Belgium

Healthcare professionals’ attitudes towards termination of pregnancy at viable stage

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