Physician counselling practices and decision‐making for extremely preterm infants in the Pacific Rim

Martinez, Alma M; Partridge, John Colin; Yu, V. Y. H.; Tan, Kang Wee; Yeung, Chap-Yung; Lu, Jen-Hur; Nishida, Hiroshi; Boo, Nam-Yum

doi:10.1111/j.1440-1754.2005.00589.x

Cited by 68 publications

(61 citation statements)

References 16 publications

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“…They may be at a disadvantage if longterm issues were not addressed prenatally, 88 because their attention is directed toward the immediate effects of interventions without consideration of long-term consequences. 88,89 Unintentionally failing to address the longer-term outcomes and their meaning to families may lead to misperceptions about future expectations.…”

Section: Quality Of Life Versus Sanctity Of Lifementioning

confidence: 98%

“…98 Research optimizing risk communication has been limited. The general public's awareness of issues related to extreme prematurity is limited, 89 and is impacted by the way in which information is presented. 107 A series of investigators and parents have advocated for increased education of the general public, especially those who are pregnant, 89 and for consideration of initiatives to create advance directives for pregnancies threatened with preterm delivery.…”

Section: Unique Circumstances: Medical Decision-making During the Prementioning

confidence: 99%

“…The general public's awareness of issues related to extreme prematurity is limited, 89 and is impacted by the way in which information is presented. 107 A series of investigators and parents have advocated for increased education of the general public, especially those who are pregnant, 89 and for consideration of initiatives to create advance directives for pregnancies threatened with preterm delivery. 111 If the goal is to optimize parental decision-making and permit parents to make decisions consistent with their own moral framework, then continued research is needed into the process, factors that impede or promote an informed decision, and strategies to maximize consistent and stable decisions for parents.…”

Section: Unique Circumstances: Medical Decision-making During the Prementioning

confidence: 99%

See 2 more Smart Citations

Care at the Edge of Viability: Medical and Ethical Issues

Haward

Kirshenbaum

Campbell

2011

Clinics in Perinatology

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Section: Quality Of Life Versus Sanctity Of Lifementioning

confidence: 98%

Section: Unique Circumstances: Medical Decision-making During the Prementioning

confidence: 99%

Section: Unique Circumstances: Medical Decision-making During the Prementioning

confidence: 99%

See 1 more Smart Citation

Care at the Edge of Viability: Medical and Ethical Issues

Haward

Kirshenbaum

Campbell

2011

Clinics in Perinatology

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“…(We have subsequently reported birth weight and gestational age thresholds for resuscitation elsewhere. 44 ) The San Francisco cohort had lower birth weights, and the Taiwan cohort had larger birth weights in comparison to the other cohorts (P Ͻ .001). The Taiwan cohort also had higher gestational ages than the Singapore and San Francisco cohorts (P Ͻ .001).…”

Section: Samplementioning

confidence: 99%

International Comparison of Care for Very Low Birth Weight Infants: Parents' Perceptions of Counseling and Decision-Making

et al. 2005

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ABSTRACT. Objective. To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.Study Design. Convenience sample of 327 parents of 379 inborn very low birth weight infants (<1501 g) who had received resuscitation and neonatal intensive care in 9 neonatal intensive care units (NICUs) in 6 Pacific Rim countries and in 2 California hospitals. The sample comprised mostly parents whose infants survived, because in some centers interviews of parents of nonsurviving infants were culturally inappropriate. Of 359 survivors for whom outcome data were asked of parents, 29% were reported to have long-term sequelae. Half-hour structured interviews were performed, using trained interpreters as necessary, at an interval of 13.7 months after the infant's birth. We compared responses to interview questions that detailed counseling patterns, factors taken into consideration in decisions, and acceptance of parental decision-making.Results. Parents' recall of perinatal counseling differed among centers. The majority of parents assessed physician counseling on morbidity and mortality as adequate in most, but not all, centers. They less commonly perceived discussions of other issues as adequate to their needs. The majority (>65%) of parents in all centers felt that they understood their infant's prognosis after physician counseling. The proportion of parents who expected long-term sequelae in their infant varied from 15% (in Kuala Lumpur, Malaysia) to 64% (in Singapore). The majority (>70%) of parents in all centers, however, perceived their infant's outcome to be better than they expected from physician counseling. A majority of parents across all centers feared that their infant would die in the NICU, and approximately one third continued to fear that their infant might die at home after nursery discharge. The parents' regard for physicians' and, to a lesser extent, partners' opinions was important in decision-making. Less than one quarter of parents perceived that physicians had made actual life-support decisions on their own except in Melbourne, Australia, and Tokyo, Japan (where 74% and 45% of parents, respectively, reported sole physician decision-making). Parents would have preferred to play a more active, but not autonomous, role in decisions made for their infants. Counseling may heighten parents' anxiety during and after their infant's hospitalization, but that does not diminish their recalled satisfaction with counseling and the decisionmaking process.Conclusions. Counseling differs by center among these centers in Australasia and California. Given that parents desire to play an active role in decision-making for their premature infant, physicians should strive to provide parents the medical information critical for informed decision-making. Given that parents do not seek sole decision-making capacity, physicians should foster parental involvement in life-support decisions to the extent app...

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“…Some physicians approach the conflict by only offering their preferred treatment. Martinez et al surveyed neonatologists and found highly variable counseling practices, with 10-80% regularly discussing withholding or withdrawing of life support [Martinez et al, 2005].…”

Section: Benefit Vs Burden-who Decides?mentioning

confidence: 99%

Palliative care for extremely premature infants and their families

Boss

2010

Dev Disabil Res Revs

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Extremely premature infants face multiple acute and chronic life-threatening conditions. In addition, the treatments to ameliorate or cure these conditions often entail pain and discomfort. Integrating palliative care from the moment that extremely premature labor is diagnosed offers families and clinicians support through the process of defining goals of care and making decisions about life support. For both the extremely premature infant who dies soon after birth and the extremely premature infant who experiences multiple complications over weeks and months in the neonatal intensive care unit, palliative care can maintain a focus on infant comfort and family support. This article highlights the ways in which palliative care can be incorporated into intensive care for all critically ill infants.

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Physician counselling practices and decision‐making for extremely preterm infants in the Pacific Rim

Cited by 68 publications

References 16 publications

Care at the Edge of Viability: Medical and Ethical Issues

Care at the Edge of Viability: Medical and Ethical Issues

International Comparison of Care for Very Low Birth Weight Infants: Parents' Perceptions of Counseling and Decision-Making

Palliative care for extremely premature infants and their families

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