P-488 Perceptions of gamete and embryo donation recipient parents about the online experimental and control programs in the TELL Tool feasibility clinical trial at immediate post-test

Study question

What are parents’ initial perceptions about the online experimental and control programs at immediate post-test?

Summary answer

Parents reported overall acceptability of the online instructions, technological navigation, length, and quality of videos, as well as suggestions for further improvement.

What is known already

Multiple investigations have examined the reasons why parents who used donated gametes or embryos, decide to inform their children that they were conceived through third-party reproduction. A consistent theme in this research is parental calls for strategies and tools to aid parents with disclosure to their children. Despite these calls from parents, little research has focused on developing new methods of delivering parent-focused materials that aim to assist parents in their disclosure process. To address this concern, we developed an online experimental program called the Tool to Empower Parental TeLling and TaLking (TELL Tool) and completed alpha testing.

Study design, size, duration

A 3-month feasibility clinical trial.

Participants/materials, setting, methods

Donor sperm, egg, and embryo recipient parents were randomized to either an experimental TELL Tool program or a control program focused on good parenting practices. Both the TELL Tool and the control programs are administered online. To date 13 parents have completed the experimental or control program and each participant has answered an immediate post-test survey about the acceptability of the program. Descriptive statistics and qualitative content analysis guided the analysis.

Main results and the role of chance

The sample consists of 13 U.S. parents between 35 to 53 years (M = 41.3 years). The parents used donated sperm (n = 5), eggs (n = 2), sperm and eggs (n = 2) or embryos (n = 4) and their children were between 1 to 12 years (M = 5.7 years). Most parents were female (n = 11) and White (n = 10). Parents were asked to rate the level of truthfulness about the acceptability of the online programs (ratings: 1 to 5, with 1 being “not at all true” to 5 being “very true”). Responses about the: (1) instructions provided for accessing the program were easy, were: range 3 to 5, M = 3.9; (2) technological navigation within the program was problematic, were: range 1 to 5, M = 2.7; (3) length of the program was too long, were: range 1 to 5, M = 3; and (4) videos within the program were helpful, were: range 3 to 5, M = 3.69. Responses to the open-ended questions provided insights to the ratings, such as parents’ statements about specific technological issues (e.g., ability to print resources, ease of navigating in-and-out of the program).

Limitations, reasons for caution

Preliminary data are reported for the feasibility trial at the immediate post-test timepoint as recruitment is ongoing. As the 3-month study unfolds, additional data will be obtained to allow for more in-depth understanding of parents’ perceptions about the acceptability of the experimental TELL Tool and control programs.

Wider implications of the findings

The acceptability of the online research for donor gamete and embryo recipient parents may illuminate access issues to these often hidden and dispersed parents and their families across the lifespan. Parents’ responses can provide a window of understanding for other decision aids that target health promotion among parents and children.

Trial registration number

NCT04841967

P–496 Alpha test results: Towards developing a digital prototype intervention to support parents’ disclosure about donor conception in the United States

Study question

The objective of the study was to determine the usability, comprehensibility, and acceptability of a digital, decision-support aid prototype supporting parental disclosure of donor conception. Summary answer: This mixed methods design maximized participant feedback about the digital, decision-support aid prototype yielding rich insight about the prototype while minimizing participant and investigator burden.

What is known already

Although a paradigm shift is underway to remove the secrecy that has historically shrouded the practice of gamete donation, little is known about best practices that can support parents in disclosing the conceptional origins to their children. To address this gap, we created a decision-support aid prototype to facilitate parental disclosure post-treatment. In doing so, we followed the International Patient Decision Aid Standards Collaboration for developing decision-support aids, which recommends that Alpha testing (i.e., usability, comprehensibility, and acceptability) be completed to improve the quality of newly created decision-support interventions prior to Beta (i.e., real world) testing.

Study design, size, duration

A mixed-methods, triangulation design was used.

Participants/materials, setting, methods

Sixteen participants were purposefully selected based on desired characteristics and the needs of the study. Participants were asked to: (1) follow investigator prepared instructions for accessing the digital, decision-support aid; (2) complete a quantitative rating form about each slide within the decision-support aid prototype; and (3) participate in a qualitative, cognitive interview or focus group. Descriptive statistics and qualitative content analysis guided the iterative analysis.

Main results and the role of chance

The sample was composed of 10 parents that used donated sperm (n = 3), oocytes (n = 4), or embryos (n = 2) to conceive children and 8 clinicians; 2 participants were both donor recipient parents and clinicians. The interviews (n = 14) and one focus group (2 participants) ranged in length from 25 to 70 minutes (M = 47 minutes).

Usability: Participants suggested refining the instructions for accessing the decision-support aid and upgrading the technology used to deliver the content. Common concerns were the inconsistent volume of the audio recordings and a need for higher quality images. Comprehensibility: Feedback obtained from the participants’ rating forms and in the interviews and focus group were consistently high about the ability to understand the content and the scope of the information presented. Acceptability: Participants noted the aid would resonate with parents. They recommended shortening the length of the aid, changing specific wording, modifying some of the video content, refining specific content for individual slides and the four modules. Unintended recommendations about how the aid might be used to provide clinician education or in international research were also reported.

Limitations, reasons for caution

Alpha testing is not designed to obtain all possible technological or content issues. Rather, it is a useful and recommended step in intervention development to mitigate existing technological bugs and key content issues prior to implementation of Beta testing of a decision-support aid.

Wider implications of the findings: Other investigators that develop digital decision-support aids may consider the use of both quantitative and qualitative data collection methods during Alpha testing to refine digital interventions efficiently. The use of mixed methods not only captures rich and insightful feedback but also minimizes the burden on participants and investigators.

Trial registration number

Not applicable

'Information is information': a public perspective on incidental findings in clinical and research genome-based testing

The potential for genomic incidental findings is increasing with the use of genome-based testing. At the same time approaches to clinical decision making are shifting to shared decision-making models involving both the healthcare community and the public. The public's voice has been nearly absent in discussions on managing incidental findings. We conducted nine focus groups and nine interviews (n = 63) with a broad cross-section of lay public groups to elucidate public viewpoints on incidental findings that could occur as a result of genome-based testing in clinical and research situations. Data were analyzed using qualitative content analysis. Participants wanted incidental findings disclosed to them whether or not these were clinical or research findings. Participants used different terms to define and describe incidental findings; they wanted to know that incidental findings are possible and be given a choice to learn about them. Personal utility was an important reason for disclosure, and participants believed that managing information is a shared responsibility between professionals and themselves. Broad public input is needed in order to understand and incorporate the public's perspective on management of incidental findings as disclosure guidelines, and policies are developed in clinical and research settings.

Bedside peritoneal drainage in very low birth weight infants

BACKGROUND

Bedside peritoneal drainage is emerging as a useful therapy for premature infants with intestinal perforation in the newborn period. Some authors recommend that bedside drainage be primary therapy for very low birth weight neonates. Surprisingly, some series report up to 70% of neonates so treated never require further or definitive surgery.

METHODS

This is a retrospective chart review of all premature newborns with a diagnosis of either necrotizing enterocolitis or bowel perforation between November 1996 and May 2000.

RESULTS

Sixty-seven patients were identified, of whom 27 were treated medically only and not considered here. Thirty-two neonates were treated with laparotomy primarily, with 26 survivors. Eight neonates were treated first with bedside peritoneal drainage. Of these, 4 survived, 6 required secondary surgery for obstruction or infection, and 2 died before any further intervention.

CONCLUSIONS

Bedside peritoneal drainage is a useful adjunct in the approach to treating the very sick, very low birth weight neonate with evidence of intestinal perforation. Our experience does not support drainage as definitive therapy.

Corticosteroids in the management of unresected plasma cell granuloma (inflammatory pseudotumor) of the lung

The case of a 10-year-old girl with plasma cell granuloma of the lung and an associated hypergammaglobulinemia is reported. A thoracotomy and biopsy were done. Total resection would have required a pneumonectomy. She was treated with an immunosuppressive course of prednisone, which resulted in a reversal of the infiltrative process and the hypergammaglobulinemia.