Influence of Maternal Factors in Neonatologists' Counseling for Periviable Pregnancies

Kunkel, Melissa; Downs, Stephen M.; Edmonds, Brownsyne Tucker

doi:10.1055/s-0037-1598247

Cited by 19 publications

(8 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some participants were even uncomfortable talking about it. Other studies on the impact pf parents’ characteristics on decision-making for resuscitation of EPIs focused mainly on the impact of race, marital status, or financial resources and as such were not directly comparable with our results ( 38 – 40 ). However, another Belgian study on nurses’ and neonatologists’ perceptions on end-of-life decisions found that some struggle to consider parents’ socioeconomic status and that others reflect on its ethical implications ( 41 ).…”

Section: Discussioncontrasting

confidence: 99%

Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study

et al. 2022

View full text Add to dashboard Cite

ObjectiveDeciding whether initiating or withholding resuscitation at birth for extremely preterm infants (EPIs) can be difficult due to uncertainty on outcomes. Clinical uncertainty generates ethical uncertainty. Thus, physicians’ attitudes and perspectives on resuscitation of EPIs might influence resuscitation decisions. We aimed at understanding how neonatologists make clinical-ethical decisions for EPI resuscitation and how they perceive these decisions.MethodsWe performed a qualitative study using a constructivist account of grounded theory. Face-to-face, semi-structured in-depth interviews with neonatologists comprised data collection. For data analysis, we used the Qualitative Analysis Guide of Leuven.ResultsWe interviewed 20 neonatologists working in 10 hospitals in Belgium. Participants’ decision-making can be described as consensus-based, gestational age-based, contextualized, progressive, and shared. All participants agreed on the importance of using the consensus expressed in guidelines as a guidance for the decision-making, i.e., consensus-based. Consequently, all 20 participants use GA thresholds indicated in the guidelines, i.e., GA-based. However, they use these thresholds differently in their decisions. Few participants rigidly follow established thresholds. The vast majority reported using additional contextual factors as birthweight or parents’ wishes in the decision-making, rather than only the EPIs’ GA, i.e., contextualized. All participants agreed on the importance of involving the parents in the decision-making, i.e., shared, and indeed parents’ wishes were among the most valued factors considered in the decision-making. However, the extent to which parents were involved in the decision-making depended on the infant’s GA. Participants described a gray zone in which parents’ were viewed as the main decision-makers due to the high clinical uncertainty. This mean that participants tend to follow parents’ request even when they disagree with it. Outside the gray zone, physicians were viewed as the main decision-makers. This mean that, although parents’ wishes were still considered, counseling was more directive and the final decision was made by the physician.ConclusionAlthough an EPI’s GA remains the main factor guiding neonatologists’ resuscitation decisions, other factors are seriously considered in the decision-making process. All neonatologist participants agreed on the importance of involving parents in the decision-making. However, they involve parents differently depending on the EPI’s GA.

show abstract

Section: Discussioncontrasting

confidence: 99%

Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…28 Finally, in 3 studies, researchers found that maternal characteristics can also influence physicians' attitudes toward resuscitation. In Kunkel et al, 39 parity, planned pregnancy, and race had a statistically significant impact on physicians' willingness to resuscitate an EPI. Similarly, in 2 studies in which physicians were asked to give opinions on 2 scenarios in which EPIs' characteristics remained constant but maternal characteristics (eg, age, marital status, parity) varied, maternal characteristics were found to significantly affect physicians' willingness to resuscitate.…”

Section: Impact Of Physicians' Characteristics On Attitudes Toward Parental Requestsmentioning

confidence: 94%

“…We found 2 exceptions to these trends. 27,32 variability of physicians' attitudes influenced by non-patient-related factors found that maternal characteristics 39,44,47 and fear of litigation 28 greatly affected physicians' attitudes. We also found that certain physicians' demographic characteristics also have an impact, suggesting that an interplay of various factors, rather than GA alone, influences physicians' attitudes.…”

Section: Physicians' Attitudes Toward Resuscitation and Nonresuscitationmentioning

confidence: 99%

Physicians’ Attitudes on Resuscitation of Extremely Premature Infants: A Systematic Review

Cavolo

Casterlé²,

Naulaers

et al. 2019

Pediatrics

View full text Add to dashboard Cite

CONTEXT: Whether to resuscitate extremely premature infants (EPIs) is a clinically and ethically difficult decision to make. Indications and practices vary greatly across different countries and institutions, which suggests that resuscitation decisions may be influenced more by the attitudes of the individual treating physicians. Hence, gaining in-depth insight into physicians' attitudes improves our understanding of decision-making regarding resuscitation of EPIs.OBJECTIVE: To better understand physicians' attitudes toward resuscitation of EPIs and factors that influence their attitudes through a systematic review of the empirical literature.

show abstract

“…Similarly, physicians may not be fully equipped to clarify parental values and fail to recognise that parental perspectives can be unclear and open to interpretation or misinterpretation. 15,[36][37][38] This can make it challenging to provide guidance and support to parents. One perspective can be interpreted differently by different parents and lead to different decisions, so that some will decide to initiate intensive care treatment and others comfort care, based on the same perspective.…”

Section: Discussionmentioning

confidence: 99%

A scoping review of parental values during prenatal decisions about treatment options after extremely premature birth

Boer

Vries

Berken³

et al. 2023

Acta Paediatrica

View full text Add to dashboard Cite

Parents need to be involved in prenatal decisions about neonatal treatment if their baby is likely to be born extremely premature -in the so-called grey zone, which is between 22 and 26 weeks of gestation, depending on time, country and culture. [1][2][3] The two treatment options in this grey zone are intensive care and comfort care.Intensive care treatment comes with great uncertainty regarding the outcome: some infants will not survive, some will go through life with one or more disabilities, and others will grow up without any problems. 4 As decisions in the grey zone are value laden, 5 a shared decisionmaking approach is recommended. [6][7][8][9] This involves mutual recognition of the need for a decision, followed by a discussion of the treatment options with their pros and cons, as well as an exploration of the parental values to be incorporated. 10,11 This exploration, known as values clarification, will allow treatment decisions to be aligned with personal goals and circumstances. 12 When a prenatal

show abstract

Influence of Maternal Factors in Neonatologists' Counseling for Periviable Pregnancies

Cited by 19 publications

References 40 publications

Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study

Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study

Physicians’ Attitudes on Resuscitation of Extremely Premature Infants: A Systematic Review

A scoping review of parental values during prenatal decisions about treatment options after extremely premature birth

Contact Info

Product

Resources

About