Prenatal Consultation Practices at the Border of Viability: A Regional Survey

Bastek, Tara K; Richardson, Douglas K.; Zupancic, John A.F.; Burns, Jeffrey P.

doi:10.1542/peds.2004-1427

Cited by 108 publications

(54 citation statements)

References 33 publications

(30 reference statements)

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“…The results support the lack of perceived influence of religion on decisionmaking found in previous reports 20,30,31 and differ from studies that report that physicians with <10 years of experience were more willing to withhold resuscitation due to parental request. 6,32 Limitations This study has several limitations.…”

Section: Other Influencessupporting

confidence: 68%

Decision-making in the delivery room: a survey of neonatologists

Binns

et al. 2007

J Perinatol

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Objective: To examine influences on neonatologists' decision-making regarding resuscitation of extremely premature infants.Study Design: A mailed survey of Illinois neonatologists evaluated influences on resuscitation. Personal and parentally opposed (that is, acting against parental wishes) gray zones of resuscitation were defined, with the lower limit (LL) the gestational age at or below which resuscitation would be consistently withheld and the upper limit (UL) above which resuscitation was mandatory.Result: Among the 85 respondents, LL and UL of the personal and parentally opposed gray zones were median 22 and 25 weeks, respectively. Neonatologists with an UL personal gray zone <25 completed weeks were significantly more fearful of litigation, more likely to have received didactic/continuing medical education teaching, and less likely to always consider parents' opinions in resuscitation decisions. Neonatologists with an UL parentally opposed gray zone <25 completed weeks were more fearful of litigation. Conclusion:Neonatologists perceive a 'gray zone' of resuscitative practices and should understand that external influences may affect their delivery room resuscitation practices.

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Section: Other Influencessupporting

confidence: 68%

Decision-making in the delivery room: a survey of neonatologists

Binns

et al. 2007

J Perinatol

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“…Multiple studies suggest that these discussions tend to revolve heavily around the data neonatologists believe is necessary to facilitate literal life-and-death decisions. 2,3,[6][7][8] Yet qualitative research exploring the needs of parents confronted with these situations demonstrates that they often need more than just data from their doctors. Parents who were interviewed after receiving neonatal consultation prior to the birth of an extremely premature infant consistently stressed the importance of establishing a trusting and hopeful relationship with the physician.…”

Section: Inadequate Antenatal Counseling In Practicementioning

confidence: 99%

“…[2][3][4][5][6] During the simulation, the fellows dutifully presented, from "head-to-toe," a detailed and accurate description of the common risks facing an infant born at this gestational age, including intra-ventricular hemorrhage, respiratory distress syndrome, chronic lung disease, patent ductus arteriosus, and necrotizing enterocolitis. They discussed umbilical lines and blood transfusions.…”

mentioning

confidence: 99%

Teaching antenatal counseling skills to neonatal providers

Stokes

Watson

Boss

2014

Seminars in Perinatology

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“…First, as noted in the previous literature, most of our participants did attempt to elicit the mother's values, but fewer acknowledged that this was a difficult decision with uncertainty in the outcome. Review of the literature notes that families find these two themes very important in their counseling (6). We think this underlines the need for further improvement in how we communicate with our patients and will be a focus in the next phase of VANESSA's development.…”

Section: Discussionmentioning

confidence: 92%

Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA): Pilot Study (Preprint)

Motz¹,

Gray²,

Sawyer³

et al. 2017

Preprint

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BACKGROUND Prenatal counseling at the limits of newborn viability involves sensitive interactions between neonatal providers and families. Empathetic discussions are currently learned through practice in times of high stress. Decision aids may help improve provider communication but have not been universally adopted. Virtual standardized patients are increasingly recognized as a modality for education, but prenatal counseling simulations have not been described. To be valuable as a tool, a virtual patient would need to accurately portray emotions and elicit a realistic response from the provider. OBJECTIVE To determine if neonatal providers can accurately identify a standardized virtual prenatal patient’s emotional states and examine the frequency of empathic responses to statements made by the patient. METHODS A panel of Neonatologists, Simulation Specialists, and Ethicists developed a dialogue and identified empathic responses. Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA), a screen-based simulation of a woman at 23 weeks gestation, was capable of displaying anger, fear, sadness, and happiness through animations. Twenty-four neonatal providers, including a subgroup with an ethics interest, were asked to identify VANESSA’s emotions 28 times, respond to statements, and answer open-ended questions. The emotions were displayed in different formats: without dialogue, with text dialogue, and with audio dialogue. Participants completed a post-encounter survey describing demographics and experience. Data were reported using descriptive statistics. Qualitative data from open ended questions (eg, “What would you do?”) were examined using thematic analysis. RESULTS Half of our participants had over 10 years of clinical experience. Most participants reported using medical research (18/23, 78%) and mortality calculators (17/23, 74%). Only the ethics-interested subgroup (10/23, 43%) listed counseling literature (7/10, 70%). Of 672 attempts, participants accurately identified VANESSA’s emotions 77.8% (523/672) of the time, and most (14/23, 61%) reported that they were confident in identifying these emotions. The ethics interest group was more likely to choose empathic responses (P=.002). Participants rated VANESSA as easy to use (22/23, 96%) and reported that she had realistic dialogue (15/23, 65%). CONCLUSIONS This pilot study shows that a prenatal counseling simulation is feasible and can yield useful data on prenatal counseling communication. Our participants showed a high rate of emotion recognition and empathy in their responses.

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Prenatal Consultation Practices at the Border of Viability: A Regional Survey

Cited by 108 publications

References 33 publications

Decision-making in the delivery room: a survey of neonatologists

Decision-making in the delivery room: a survey of neonatologists

Teaching antenatal counseling skills to neonatal providers

Virtual Antenatal Encounter and Standardized Simulation Assessment (VANESSA): Pilot Study (Preprint)

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