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

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

Research output: Contribution to journalArticle

6 Scopus citations

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)
Pages (from-to)175-182
Number of pages8
JournalAJOB Empirical Bioethics
Volume7
Issue number3
DOIs
StatePublished - Jul 2 2016

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

Fingerprint Dive into the research topics of 'A pilot study of neonatologists' decision-making roles in delivery room resuscitation counseling for periviable births'. Together they form a unique fingerprint.

  • Cite this