Annie Janvier1, John M Lorenz, John D Lantos. 1. Division of Neonatology and Clinical Ethics, Department of Pediatrics, University of Montreal, Sainte-Justine Hospital, Montreal, QC, Canada. anniejanvier@hotmail.com
Abstract
UNLABELLED: When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines. CONCLUSION: We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.
UNLABELLED: When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines. CONCLUSION: We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.
Authors: Annie Janvier; Keith J Barrington; Khalid Aziz; Eduardo Bancalari; Daniel Batton; Carlo Bellieni; Brahim Bensouda; Carlos Blanco; Po-Yin Cheung; Felicia Cohn; Thierry Daboval; Peter Davis; Eugene Dempsey; Amélie Dupont-Thibodeau; Emanuela Ferretti; Barbara Farlow; Matteo Fontana; Etienne Fortin-Pellerin; Aviva Goldberg; Thor Willy Ruud Hansen; Marlyse Haward; Lajos Kovacs; Anie Lapointe; John Lantos; Colin Morley; Ahmed Moussa; Gabriel Musante; Sophie Nadeau; Colm Pf O'Donnell; Kristina Orfali; Antoine Payot; C Anthony Ryan; Guilherme Sant'anna; Ola D Saugstad; Sadath Sayeed; Theophil A Stokes; Eduard Verhagen Journal: Paediatr Child Health Date: 2014-01 Impact factor: 2.253
Authors: Monica E Lemmon; Hanna Huffstetler; Mary Carol Barks; Christine Kirby; Madelaine Katz; Peter A Ubel; Sharron L Docherty; Debra Brandon Journal: Pediatrics Date: 2019-07 Impact factor: 7.124