A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births
dc.contributor.author | Tucker Edmonds, Brownsyne | |
dc.contributor.author | McKenzie, Fatima | |
dc.contributor.author | Panoch, Janet E. | |
dc.contributor.author | White, Douglas B. | |
dc.contributor.author | Barnato, Amber E. | |
dc.contributor.department | Obstetrics and Gynecology, School of Medicine | en_US |
dc.date.accessioned | 2018-05-15T14:31:57Z | |
dc.date.available | 2018-05-15T14:31:57Z | |
dc.date.issued | 2016-07 | |
dc.description.abstract | BACKGROUND: Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions. METHODS: We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?" RESULTS: Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. CONCLUSIONS: Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice. | en_US |
dc.eprint.version | Author's manuscript | en_US |
dc.identifier.citation | Tucker Edmonds, B., McKenzie, F., Panoch, J. E., White, D. B., & Barnato, A. E. (2016). A Pilot Study of Neonatologists’ Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births. AJOB Empirical Bioethics, 7(3), 175–182. | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/16182 | |
dc.language.iso | en_US | en_US |
dc.publisher | Taylor and Francis | en_US |
dc.relation.journal | AJOB Empirical Bioethics | en_US |
dc.rights | Publisher Policy | en_US |
dc.source | PMC | en_US |
dc.subject | Mechanical ventilation | en_US |
dc.subject | Neonatal intensive care | en_US |
dc.subject | Patient-doctor communication | en_US |
dc.subject | Perinatal palliative care | en_US |
dc.subject | Periviability | en_US |
dc.subject | Shared decision making | en_US |
dc.title | A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births | en_US |
dc.type | Article | en_US |