A pilot study of neonatologists' decision-making roles in delivery room resuscitation counseling for periviable births

Brownsne Tucker Edmonds, Fatima McKenzie, Janet E. Panoch, Douglas B. White, Amber E. Barnato

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 postencounter 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 postsimulation 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.

Original languageEnglish (US)
JournalAJOB Empirical Bioethics
DOIs
StateAccepted/In press - Oct 14 2015

Fingerprint

Delivery Rooms
Resuscitation
Counseling
counseling
Decision Making
Parturition
decision making
deliberation
interview
physician
counseling session
communication behavior
simulation
Interviews
decision-making process
coding
content analysis
Physicians
management
Neonatologists

Keywords

  • mechanical ventilation
  • neonatal intensive care
  • patient–doctor communication
  • perinatal palliative care
  • periviability
  • shared decision making

ASJC Scopus subject areas

  • Health(social science)
  • Philosophy
  • Health Policy

Cite this

A pilot study of neonatologists' decision-making roles in delivery room resuscitation counseling for periviable births. / Tucker Edmonds, Brownsne; McKenzie, Fatima; Panoch, Janet E.; White, Douglas B.; Barnato, Amber E.

In: AJOB Empirical Bioethics, 14.10.2015.

Research output: Contribution to journalArticle

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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 postencounter 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 postsimulation 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.",
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N2 - 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 postencounter 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 postsimulation 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.

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