What Information Do Clinicians Deem Important for Counseling Parents Facing Extremely Early Deliveries?: Results from an Online Survey

Abstract

Objective The study aimed to better understand how neonatology and maternal fetal medicine (MFM) physicians convey information during antenatal counseling that requires facilitating shared decision-making with parents facing options of resuscitation versus comfort care after extremely early delivery Study Design Attending physicians at US centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. The survey assessed information conveyed, processes for facilitating shared decision-making (reported separately), and clinical experiences. Neonatology and MFM responses were compared. Multivariable logistic regression analyzed topics often and seldom discussed by specialty groups with respect to respondents' clinical experience and resuscitation option preferences at different gestational weeks. Results In total, 74 MFM and 167 neonatologists representing 94% of the 81 centers surveyed responded. Grouped by specialty, respondents were similar in counseling experience and distribution of allowing choices between resuscitation and no resuscitation for delivery at specific weeks of gestational ages. MFM versus neonatology reported similar rates of discussing long-term health and developmental concerns and differed in all other categories of topics. Neonatologists were less likely than MFM to discuss caregiver impacts (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.11–0.18, p < 0.001) and comfort care details (OR: 0.19, 95% CI: 0.15–0.25, p < 0.001). Conversely, neonatology versus MFM respondents more frequently reported “usually” discussing topics pertaining to parenting in the NICU (OR: 1.5, 95% CI: 1.2–1.8, p < 0.001) and those regarding stabilizing interventions in the delivery room (OR: 1.8, 95% CI: 1.4–2.2, p < 0.001). Compared with less-experienced respondents, those with 17 years’ or more of clinical experience had greater likelihood in both specialties to say they “usually” discussed otherwise infrequently reported topics pertaining to caregiver impacts. Conclusion Parents require information to make difficult decisions for their extremely early newborns. Our findings endorse the value of co-consultation by MFM and neonatology clinicians and of trainee education on antenatal consultation education to support these families. Key Points

How do Clinicians View the Process of Shared Decision-Making with Parents Facing Extremely Early Deliveries? Results from an Online Survey

“…We previously reported that our survey respondent MFMs and Neos convey different information topics when counseling parents facing delivery at extremely early gestational ages. 16 Here, we demonstrate that these specialists also differ in how they engage in the process of SDM with these families. Because they often are the primary practitioners for these hospitalized women, MFMs report seeing them with more continuity during their hospital stay.…”

“…The survey consisted of three parts: views on facilitating the SDM process, respondents' extent of counseling practices and demographics, and information topics included in counseling (results of information topics are reported separately). 16 Respondents were asked to reflect upon their own experiences of SDM counseling for parents facing extremely early delivery when both resuscitation and comfort care were being considered. Respondents rated on Likert scales their perceived efficacy in achieving goals of SDM supported by the literature (e.g., showing compassion, eliciting parents' hopes, and values), their perceptions of what parents find important to decision-making, the level of difficulty certain situations posed to SDM, and the appropriateness of sharing one's personal views as a clinician.…”

“…In a previous publication, we reported results of our survey of MFM and Neos that examined their prioritization of information given to parents in these antenatal counseling ahead of extremely early delivery. 16 Here, we report from that survey these clinicians' views on the process of facilitating SDM for infants born at less than 25 weeks gestation, specifically, their perceived efficacy in achieving goals of communication, challenges to effective SDM, and analysis of individuals' SDM views with respect to their specialty and other characteristics. Clinicians' self-assessments of their strengths, weaknesses, and perceptions of what is important to parents can help focus educational efforts and will be compared with the responses of parents in an ongoing multi-center study of parents' preferences.…”

Increasing Realism and Variety of Virtual Patient Dialogues for Prenatal Counseling Education Through a Novel Application of ChatGPT: Exploratory Observational Study

“…Although most responses were relevant, some topics, such as spirituality and shared decision-making, did not come up in the role-play conversations. Previous studies have demonstrated that providers perceive the importance of parents' spirituality in their decision-making and infrequently discuss these spiritual beliefs with parents in antenatal consultations [35,36]. Further work exploring how families might express their spirituality or explore shared decisions would be needed to ensure these topics are included in a VSP [37][38][39].…”