Evaluating shared decision-making in periviable counseling using objective structured clinical examinations

Edmonds, Brownsyne Tucker; McKenzie, Fatima; Panoch, Janet; Litwiller, Abigail; DiCorcia, Mark J.

doi:10.1038/s41372-019-0366-1

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…A previous study showed that not all Dutch parents who had experienced an extremely preterm birth had been aware of the prenatal decisions to be made in the grey zone 11 . Studies from the United States have shown that healthcare professionals sometimes failed to fulfil the requirements of shared decision‐making 12,13 . In contrast, high levels of perceived shared decision‐making were reported among Dutch parents and physicians in 2021 14 …”

Section: Discussionmentioning

confidence: 99%

“…11 Studies from the United States have shown that healthcare professionals sometimes failed to fulfil the requirements of shared decision-making. 12,13 In contrast, high levels of perceived shared decision-making were reported among Dutch parents and physicians in 2021. 14 It is remarkable that the Dutch healthcare professionals who took part in this study preferred to incorporate parental values into decision-making, but the majority still wanted to keep 24 weeks of gestation as the lowest limit for early intensive care.…”

Section: Do You Agree With the Following Statement: 'I Think That It ...mentioning

confidence: 99%

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Dutch professionals' discussion preferences with the parents of extremely premature infants varied, but the trend was towards shared decision‐making

Geurtzen¹,

Proost

Verhagen

et al. 2023

Acta Paediatrica

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Aim We explored professionals' views on sharing decision‐making with parents before and after an extremely preterm birth and what healthcare professionals considered severe outcomes. Methods A nationwide, multi‐centre online survey was carried out among a wide range of perinatal healthcare professionals in the Netherlands from 4 November 2020 to 10 January 2021. The medical chairs of all nine Dutch Level III and IV perinatal centres helped to disseminate the survey link. Results We received 769 survey responses. Most respondents (53%) preferred to place equal emphasis on two treatment options during shared prenatal decision‐making: early intensive care or palliative comfort care. The majority (61%) wanted to include a conditional intensive care trial as a third treatment option, but 25% disagreed. Most (78%) felt that healthcare professionals were responsible for initiating postnatal conversations to justify continuing or withdrawing neonatal intensive care if complications were associated with poor outcomes. Finally, 43% were satisfied with the current definitions of severe long‐term outcomes, 41% were unsure and there were numerous for a broader definition. Conclusion Although Dutch professionals expressed diverse preferences on how to reach decisions about extremely premature infants, we observed a trend towards shared decision‐making with parents. These results could inform future guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Do You Agree With the Following Statement: 'I Think That It ...mentioning

confidence: 99%

Dutch professionals' discussion preferences with the parents of extremely premature infants varied, but the trend was towards shared decision‐making

Geurtzen¹,

Proost

Verhagen

et al. 2023

Acta Paediatrica

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“…For purposes of this study, we expanded that item into two separate items, specifically to assess residents' discussions of the risks (item 4a) and benefits (item 4b) associated with the multitude of contraceptive methods that can be presented to the SP. A similar version of this codebook has been used in other OSCEs at our institution to assess the use of SDM in discussions pertaining to periviable delivery 35 and vaginal birth after cesarean. 36 Each item was assigned a score of absent (0 points), partial (1 point), or complete (2 points).…”

Section: Methodsmentioning

confidence: 99%

Evaluating Shared Decision-Making in Postpartum Contraceptive Counseling Using Objective Structured Clinical Examinations

Edmonds

Hoffman

Laitano

et al. 2022

Women's Health Reports

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Background: Shared decision-making (SDM) may support widespread uptake of progestin-containing long-acting reversible contraceptives in the immediate postpartum period. We piloted an Objective Structured Clinical Examination (OSCE) to evaluate first-year obstetrics and gynecology resident physicians' use of SDM in postpartum contraception counseling. Methods: As part of their 2015 and 2016 OSCEs, first-year OB/GYN residents were instructed to provide contraceptive counseling to a Standardized Patient (SP) portraying a 29-year-old postpartum patient seen during rounds on the morning following her delivery. Three investigators independently scored each resident encounter using a 10-item rubric adapted from a 9-item SDM measure and assigned scores of 0 (absent), 1 (partial), or 2 (complete). Each encounter was video and audio recorded, then transcribed for qualitative analysis. Descriptive statistics was produced using SPSS version 24. Results: Eighteen residents participated. The majority (78%) discussed contraceptive options and timing of initiation. Nearly 33% elicited factors most important to the SP in influencing her preference. Only 6% discussed the benefits of exclusive breastfeeding, and few addressed the uncertainty of progesterone on milk supply and production. Conclusion: Although residents conveyed ample clinical information, the vast majority did not discuss elements of SDM, such as her preferences, values, and goals for future fertility and breastfeeding. Our work revealed that critical elements of SDM are often not explored and deliberated by resident physicians. Trainings ( e.g. , OSCEs) are needed to equip residents with effective communication skills to facilitate more SDM in postpartum contraceptive care.

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“…The decision of whether to initiate active care in periviable infants born at 22 to 25 weeks' gestation is influenced by several factors, including the fear of adverse outcomes, individual bias, local and national policies, medical ethics, and communication between parents and caregivers. [1][2][3][4][5] In the US, professional societies recommend an individualized approach 3 and consideration of active perinatal care, including antenatal corticosteroids 6,7 and active postnatal care 8 if resuscitation is desired. 9 The lower threshold of viability is currently considered to be 22 weeks' gestation.…”

Section: Introductionmentioning

confidence: 99%

Association of Active Postnatal Care With Infant Survival Among Periviable Infants in the US

et al. 2023

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ImportanceActive postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care.ObjectiveTo determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants.Design, Setting, and ParticipantsThis cohort study included live births from 22 to 25 weeks’ gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022.Main Outcomes and MeasuresRegional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test.ResultsWe included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks’ gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks’ gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks’ gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks’ gestation (both P &lt; .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks’ gestation (rτ[8] = 0.60; r2 = 0.36; P = .02).Conclusions and RelevanceIn this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks’ gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.

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Evaluating shared decision-making in periviable counseling using objective structured clinical examinations

Cited by 8 publications

References 24 publications

Dutch professionals' discussion preferences with the parents of extremely premature infants varied, but the trend was towards shared decision‐making

Dutch professionals' discussion preferences with the parents of extremely premature infants varied, but the trend was towards shared decision‐making

Evaluating Shared Decision-Making in Postpartum Contraceptive Counseling Using Objective Structured Clinical Examinations

Association of Active Postnatal Care With Infant Survival Among Periviable Infants in the US

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