Exploring shared decision making during antenatal counselling for anticipated extremely preterm birth
CPS ePoster Library. Barker C. Jun 1, 2017; 176613; 52
Conor Barker
Conor Barker
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Abstract
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Background: Discussions between physicians and families facing the anticipated birth of an extremely premature infant (22-25 weeks) are complex. The use of shared decision making (SDM) can support reaching a preference sensitive decision. A guideline was created to enhance SDM to facilitate decision making and increase parental and healthcare provider satisfaction with the process. Little is known about the applicability of SDM, how healthcare providers conceptualize it in their practice, or about facilitators and barriers to implementing this process during antenatal counselling for anticipated extremely preterm birth.

Objectives: The purpose of this project was to explore healthcare providers' perceptions of and perspectives about using SDM within this clinical area.

Methods: We examined data from a larger implementability assessment study during a pilot test of the above guideline. The study consisted of qualitative interviews with 25 healthcare providers (neonatologists and neonatal fellows, maternal fetal medicine specialists and fellows, obstetricians, paediatric and obstetric residents, birthing unit nurses, and neonatal nurses) involved in 5 cases at a tertiary care centre (October-November 2015). Semi-structured interviews were conducted over the phone or in person, and transcribed verbatim. Qualitative content analysis was used to code, categorize, and thematically describe the data.

Results: Many participants understood and correctly described established elements of the SDM approach. A number had positive perspectives about this model of decision making and its usefulness in this clinical context. These participants valued SDM as an effective strategy to engage parents during the decision making process. Several participants challenged the usefulness of SDM and expressed concern that this approach increased decision making difficulties. Misunderstandings of this approach were also demonstrated, concerning the premise of SDM and the physician's role in this process. Examples of perceived barriers to the use of SDM during antenatal counselling included: timing of consults (at night or under stress), increased time needed for proper SDM, fear of creating false parental hope and misunderstandings regarding infants' long term needs, uncertainty towards use at 22 weeks, and concerns about burdening parents with this decision.

Conclusion: This study has identified healthcare providers' diverse perceptions and perspectives about SDM and various factors that influence whether members of the healthcare team value SDM or are reluctant to engage in it during antenatal counselling for anticipated preterm birth. Addressing these misperceptions and barriers will help to facilitate improved implementation of this decision making model in the current setting and other facilities in the future.

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