B Tucker Edmonds1, F McKenzie1, J E Panoch1, A E Barnato2, R M Frankel3. 1. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA. 2. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 3. Mary Margaret Walther Center for Research and Education in Palliative Care, IU Simon Cancer Center, Indianapolis, IN, USA.
Abstract
OBJECTIVE: To compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling. STUDY DESIGN: Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes. RESULT: Obstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort or suffering, and uncertainty. CONCLUSION: Obstetricians and neonatologists provided complementary counseling content to patients, yet neither specialty took ownership of steroid discussions. Joint counseling and/or family meetings may minimize observed redundancy and inconsistencies in counseling.
OBJECTIVE: To compare the management options, risks and thematic content that obstetricians and neonatologists discuss in periviable counseling. STUDY DESIGN: Sixteen obstetricians and 15 neonatologists counseled simulated patients portraying a pregnant woman with ruptured membranes at 23 weeks of gestation. Transcripts from video-recorded encounters were qualitatively and quantitatively analyzed for informational content and decision-making themes. RESULT: Obstetricians more frequently discussed antibiotics (P=0.005), maternal risks (<0.001) and cesarean risks (<0.005). Neonatologists more frequently discussed neonatal complications (P=0.044), resuscitation (P=0.015) and palliative options (P=0.023). Obstetricians and neonatologists often deferred questions about steroid administration to the other specialty. Both specialties organized decision making around medical information, survival, quality of life, time and support. Neonatologists also introduced themes of values, comfort or suffering, and uncertainty. CONCLUSION:Obstetricians and neonatologists provided complementary counseling content to patients, yet neither specialty took ownership of steroid discussions. Joint counseling and/or family meetings may minimize observed redundancy and inconsistencies in counseling.
Authors: Matthew A Rysavy; Edward F Bell; Jay D Iams; Waldemar A Carlo; Lei Li; Brian M Mercer; Susan R Hintz; Barbara J Stoll; Betty R Vohr; Seetha Shankaran; Michele C Walsh; Jane E Brumbaugh; Tarah T Colaizy; Abhik Das; Rosemary D Higgins Journal: J Pediatr Date: 2019-02-06 Impact factor: 4.406
Authors: Brownsyne Tucker Edmonds; Teresa A Savage; Robert E Kimura; Sarah J Kilpatrick; Miriam Kuppermann; William Grobman; Karen Kavanaugh Journal: J Matern Fetal Neonatal Med Date: 2017-11-05
Authors: Nansi S Boghossian; Marco Geraci; Erika M Edwards; Danielle E Y Ehret; George R Saade; Jeffrey D Horbar Journal: Obstet Gynecol Date: 2020-04 Impact factor: 7.623
Authors: R Geurtzen; Arno Van Heijst; Rosella Hermens; Hubertina Scheepers; Mallory Woiski; Jos Draaisma; Marije Hogeveen Journal: BMC Pregnancy Childbirth Date: 2018-01-03 Impact factor: 3.007