Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

Abstract

ABSTRACT. Objectives. To determine the accuracy of knowledge of different health care providers regarding survival and long-term morbidity rates for very premature infants and to examine whether a focused educational intervention improves the accuracy of this knowledge and influences health care decisions.Methods. Using hypothetical case scenarios with infants at <28 weeks of gestation, we surveyed a variety of caregivers involved in perinatal communication and decision-making processes at a tertiary center that provides intensive care for neonates. We asked physicians from the pediatrics and obstetrics services and nurses and nurse practitioners from the NICU and obstetrics ward for their best estimates of survival and major long-term disability rates and for their opinions regarding the appropriateness of resuscitation and life support at each week of gestation of <29 weeks. After the survey, we educated all providers about current data on survival and long-term disability rates for preterm infants and gave them pocket-sized cards summarizing this information for reference during prenatal counseling. One month after the educational intervention and complete dissemination of the cards, a questionnaire with questions identical to those in the first survey was mailed to the same individuals.Results. Fifty-one health care providers were involved in the baseline survey. The response rates for the postintervention survey were 100% for physicians (20 of 20 subjects) and nurses (20 of 20 subjects) and 91% (10 of 11 subjects) for the nurse practitioners. In the baseline survey, statistically significant underestimates of survival rates were seen for physicians and nurses at 23 to 28 weeks of gestation and for nurse practitioners at 23 to 27 weeks of gestation. Statistically significant overestimates of disability rates were seen for physicians and nurse practitioners at <26 weeks of gestation and for nurses at <28 weeks of gestation. After the intervention, respondents demonstrated significant improvements in the accuracy of survival and disability estimates at many, but not all, gestational ages. Although underestimation of survival rates and overestimation of disability rates decreased after the intervention, it persisted to some degree. After the intervention, a larger proportion of physicians (53% vs 21%) and a smaller proportion of nurses (10% vs 37%) were likely to recommend resuscitation for infants born at 23 weeks of gestation.Conclusions. Physicians, nurses, and nurse practitioners underestimated survival rates and overestimated long-term disability rates for very premature infants. After education, their estimates of survival and long-term disability rates for these infants improved significantly. More accurate estimates of survival and disability rates affected physicians' and nurses' theoretical decisionmaking regarding the appropriateness of resuscitation at 23 weeks of gestation. Pediatrics 2005;115:e478-e487. URL: www.pediatrics.org/cgi

Clinicians prefer simple educational tools for implementing practice change

“…Pocket cards appeared to be a popular method of learning and reinforcing the practice change. This is consistent with previous literature demonstrating the effectiveness of pocket cards as part of educational strategies for implementation of new clinical practices and to improve health care provider knowledge (Blanco et al 2005;Richardson et al 2006;Mikhael et al 2008). Pocket cards are inexpensive, easily implemented and readily available educational tools.…”

Moral distress in the neonatal intensive care unit: caregiver's experience

“…The question focused on CP because it is consistently and clearly reported and is relatively stable among studies. [2][3][4] We felt that this made it a better indicator of knowledge than other, probably more important, aspects of impairment in these infants.…”

“…2,3 Both physicians and nurses routinely underestimate very preterm infants' survival and chances of a good long-term outcome, with nurses being more pessimistic than physicians. 4,5 The extent of resuscitation is known to be related to these estimates of outcomes. 6,7 We were unable to find data about residents' opinions on the subject in the literature.…”

End-of-Life Decisions in Dutch Neonatal Intensive Care Units

“…Several studies have suggested that intensivists routinely overestimate bad outcomes and conflate acute critical illness with long-term prognosis. [28][29][30][31][32][33] In addition, the question remains how the best interest of the infant should be defined and whether or not the physician is the best person to make that judgment.…”