Use of a Visual Aid to Improve Counseling at the Threshold of Viability

Kakkilaya, Venkatakrishna; Groome, Lynn J.; Platt, Daci J.; Kurepa, Dalibor; Pramanik, Arun K.; Caldito, Gloria; Conrad, Lesley B.; Bocchini, Joseph A.; Davis, Terry C.

doi:10.1542/peds.2011-0597

Cited by 54 publications

(48 citation statements)

References 33 publications

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“…The 19 included studies evaluated 21 interventions ranging from communication skills workshops or education sessions [24], [25], [38](n = 4), coaching sessions targeted at patients [43], [45] (n = 2) or health professionals [42] (n = 1), computerised decision aids [26], [30]–[32], [34], [37] (n = 5), video-based interventions to improve informed decision-making and SDM [27], [35], [36] (n = 3),counselling session [39] (n = 1), booklet or DVD decision aids [37], [40], [41] (n = 3) and paper based hand-outs promoting informed decision-making [33] (n = 2).…”

Section: Resultsmentioning

confidence: 99%

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundIncreasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities.ObjectiveTo evaluate the impact of SDM interventions on disadvantaged groups and health inequalities.DesignSystematic review and meta-analysis of randomised controlled trials and observational studies.Data SourcesCINAHL, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, HMIC, MEDLINE, the NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge were searched from inception until June 2012.Study Eligibility CriteriaWe included all studies, without language restriction, that met the following two criteria: (1) assess the effect of shared decision-making interventions on disadvantaged groups and/or health inequalities, (2) include at least 50% of people from disadvantaged groups, except if a separate analysis was conducted for this group.ResultsWe included 19 studies and pooled 10 in a meta-analysis. The meta-analyses showed a moderate positive effect of shared decision-making interventions on disadvantaged patients. The narrative synthesis suggested that, overall, SDM interventions increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict among disadvantaged patients. Further, 7 out of 19 studies compared the intervention's effect between high and low literacy groups. Overall, SDM interventions seemed to benefit disadvantaged groups (e.g. lower literacy) more than those with higher literacy, education and socioeconomic status. Interventions that were tailored to disadvantaged groups' needs appeared most effective.ConclusionResults indicate that shared decision-making interventions significantly improve outcomes for disadvantaged patients. According to the narrative synthesis, SDM interventions may be more beneficial to disadvantaged groups than higher literacy/socioeconomic status patients. However, given the small sample sizes and variety in the intervention types, study design and quality, those findings should be interpreted with caution.

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Section: Resultsmentioning

confidence: 99%

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

et al. 2014

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“…Supportive material can be useful in prenatal counseling, either as written information [38] or as a DA [17, 18, 25]. The potential impossibility to personalize and to use up-to-date statistics raised concerns to our participants.…”

Section: Discussionmentioning

confidence: 99%

“…Material can be personalized by doctors, for example by simply underlining and outlining what is of more or less relevance regarding the (medical) situation of the infant and wishes of the parents. Furthermore, cross-cultural differences in treatment-guidelines, language, and outcome data should encourage local institutions to develop their own material based on the positive experiences described [17, 18, 25, 38, 39]. …”

Section: Discussionmentioning

confidence: 99%

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Professionals’ preferences in prenatal counseling at the limits of viability: a nationwide qualitative Dutch study

Geurtzen¹,

Heijst²,

Draaisma³

et al. 2017

Eur J Pediatr

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Prenatal counseling practices at the limits of viability do vary, and constructing a counseling framework based on guidelines, professional and parental preferences, might achieve more homogeneity. We aimed to gain insight into professionals’ preferences on three domains of counseling, particularly content, organization, and decision making and their influencing factors. A qualitative, nationwide in-depth exploration among Dutch perinatal professionals by semi-structured interviews in focus groups was performed. Regarding content of prenatal counseling, preparing parents on the short-term situation (delivery room care) and revealing their perspectives on “quality of life” were considered important. Parents should be informed on the kind of decision, on the difficulty of individual outcome predictions, on survival and mortality figures, short- and long-term morbidity, and the burden of hospitalization. For organization, the making of and compliance with agreements between professionals may promote joint counseling by neonatologists and obstetricians. Supportive materials were considered useful but only when up-to-date, in addition to the discussion and with opportunity for personalization. Regarding decision making, it is not always clear to parents that a prenatal decision needs to be made and they can participate, influencing factors could be, e.g., unclear language, directive counseling, overload of information, and an immediate delivery. There is limited familiarity with shared decision making although it is the preferred model. Conclusion: This study gained insight into preferred content, organization, and decision making of prenatal counseling at the limits of viability and their influencing factors from a professionals’ perspective. What is Known: • Heterogeneity in prenatal counseling at the limits of viability exists • Differences between preferred counseling and actual practice also exists What is New: • Insight into preferred content, organization, and decision making of prenatal periviability counseling and its influencing factors from a professionals’ perspective. Results should be taken into account when performing counseling. • Particularly the understanding of true shared decision making needs to be improved. Furthermore, implementation of shared decision making in daily practice needs more attention.

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“…65 Visual aids, such as pictures, graphics, and short messages about resuscitation and complications associated with extreme preterm birth, enhance parental knowledge regarding survival and morbidities, although 1 study found that they did not seem to alter parental desire for resuscitation. 66 Also, although the use of visual aids improves the understanding of inexperienced parents, those who have previously had experience with a preterm birth gained little from the aids. 67 If written or other visual aids are used, the level of comprehension and literacy of the parent needs to be considered.…”

Section: Communication With Parentsmentioning

confidence: 99%

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Cummings¹,

Watterberg²,

Eichenwald³

et al. 2015

Pediatrics

223

133

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The anticipated birth of an extremely low gestational age (<25 weeks) infant presents many difficult questions, and variations in practice continue to exist. Decisions regarding care of periviable infants should ideally be well informed, ethically sound, consistent within medical teams, and consonant with the parents’ wishes. Each health care institution should consider having policies and procedures for antenatal counseling in these situations. Family counseling may be aided by the use of visual materials, which should take into consideration the intellectual, cultural, and other characteristics of the family members. Although general recommendations can guide practice, each situation is unique; thus, decision-making should be individualized. In most cases, the approach should be shared decision-making with the family, guided by considering both the likelihood of death or morbidity and the parents’ desires for their unborn child. If a decision is made not to resuscitate, providing comfort care, encouraging family bonding, and palliative care support are appropriate.

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Use of a Visual Aid to Improve Counseling at the Threshold of Viability

Abstract: Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.

Cited by 54 publications

References 33 publications

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

Professionals’ preferences in prenatal counseling at the limits of viability: a nationwide qualitative Dutch study

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

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