Comparing neonatal morbidity and mortality estimates across specialty in periviable counseling

Brownsyne Tucker Edmonds, Fatima McKenzie, Janet E. Panoch, Richard M. Frankel

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Objective: To describe and compare estimates of neonatal morbidity and mortality communicated by neonatologists and obstetricians in simulated periviable counseling encounters.Methods: A simulation-based study of 16 obstetricians (OBs) and 15 neonatologists counseling standardized patients portraying pregnant women with ruptured membranes at 23 weeks gestation. Two investigators tabulated all instances of numerically-described risk estimates across individuals and by specialty.Results: Overall, 12/15 (80%) neonatologists utilized numeric estimates of survival; 6/16 (38%) OBs did. OBs frequently deferred the discussion of "exact numbers" to neonatologists. The 12 neonatologists provided 13 unique numeric estimates, ranging from 3% to 50% survival. Half of those neonatologists provided two to three different estimates in a single encounter. By comparison, six OBs provided four unique survival estimates ("50%", "30-40%", "1/3-1/2", "<10%"). Only 2/15 (13%) neonatologists provided numeric estimates of survival without impairment. None of the neonatologists used the term "intact" survival, while five OBs did. Three neonatologists gave numeric estimates of long-term disability and one OB did.Conclusion: We found substantial variation in estimates and noteworthy omissions of discussions related to long-term morbidity. Across specialties, we noted inconsistencies in the use and meaning of terms like "intact survival." More tools and training are needed to improve the quality and consistency of periviable risk-communication.

Original languageEnglish (US)
Pages (from-to)2145-2149
Number of pages5
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume28
Issue number18
DOIs
StatePublished - Dec 12 2015

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Keywords

  • Doctor-patient communication
  • extreme prematurity
  • periviability
  • risk-communication

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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