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Haward MF, Lucena MH, Fuloria M. Research Ethics in Pregnancy: The Maternal-Fetal Dyad. Neoreviews 2023; 24:e607-e615. [PMID: 37777609 DOI: 10.1542/neo.24-10-e607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Pregnant persons and their physicians often make decisions for health care without clinical evidence to guide their choices. Years of exclusionary practices in research, dominated by fears of fetal harm, have resulted in limited evidence on therapies for pregnancy-specific conditions. It has also eroded pregnant persons' rights as autonomous individuals capable of weighing risks and benefits to make choices for themselves and their infants based on sound evidence. A paradigm shift from "routine exclusion" to "fair inclusion" of pregnant persons in clinical trials is needed to ensure that ethical principles are upheld when undertaking research in this population. This article will provide a brief review of the historical aspects of clinical research ethics for pregnant persons, focus on some key concepts within the context of the maternal-fetal dyad, and include a recent example from the coronavirus disease 2019 (COVID-19) pandemic to understand how society has interpreted tensions among the ethical principles of justice, beneficence, nonmaleficence, and autonomy. Note: This review uses the term "pregnant person(s)" to include women and people who are pregnant and do not identify themselves as women.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Michelle H Lucena
- Department of Pediatrics, Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Mamta Fuloria
- Department of Pediatrics, Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
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Haward MF, Lorenz JM, Janvier A, Fischhoff B. Antenatal consultation and deliberation: adapting to parental preferences. J Perinatol 2023; 43:895-902. [PMID: 36725985 DOI: 10.1038/s41372-023-01605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts. STUDY DESIGN Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience. RESULTS Non-clinician participants' (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who - parent or clinician - should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents' would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently. CONCLUSIONS Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - John M Lorenz
- Department of Pediatrics, Morgan Stanley Children Hospital of New York and Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal and Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, QC, Canada
| | - Baruch Fischhoff
- Institute for Politics and Strategy, and Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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Abstract
OBJECTIVE The study aimed to explore experiences of extremely preterm infant loss in the delivery room and perspectives about antenatal consultation. STUDY DESIGN Bereaved participants were interviewed, following a semi-structured protocol. Personal narratives were analyzed with a mixed-methods approach. RESULTS In total, 13 participants, reflecting on 17 pregnancies, shared positive, healing and negative, harmful interactions with clinicians and institutions: feeling cared for or abandoned, doubted or believed, being treated rigidly or flexibly, and feeling that infant's life was valued or not. Participants stressed their need for personalized information, individualized approaches, and affective support. Their decision processes varied; some wanted different things for themselves than what they recommended for others. These interactions shaped their immediate experiences, long-term well-being, healing, and regrets. All had successful subsequent pregnancies; few returned to institutions where they felt poorly treated. CONCLUSION Antenatal consultations can be strengthened by personalizing them, within a strong caregiver relationship and supportive institutional practices. KEY POINTS · Personalized antenatal consultations should strive to balance cognitive and affective needs.. · Including perspectives from bereaved parents can strengthen antenatal consultations.. · Trusting provider-parent partnerships are pivotal for risk communication..
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - John M Lorenz
- Department of Pediatrics, Morgan Stanley Children Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montréal, Canada.,Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, Canada
| | - Baruch Fischhoff
- Department of Engineering and Public Policy and Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Haward MF, Janvier A, Lorenz JM. Using the COVID-19 as an excuse for unjustified devaluation of preterm infants. Acta Paediatr 2021; 110:1097-1099. [PMID: 33426735 PMCID: PMC8014586 DOI: 10.1111/apa.15744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marlyse F. Haward
- Department of Pediatrics Children’s Hospital at Montefiore Albert Einstein College of Medicine Bronx NY USA
| | - Annie Janvier
- Department of Pediatrics, Bureau de l’Éthique Clinique Université de Montréal Montréal QC Canada
- Division of Neonatology, Research Center Clinical Ethics Unit Palliative Care Unit Unité de recherche en éthique clinique et partenariat famille CHU Sainte‐Justine Montréal QC Canada
| | - John M. Lorenz
- Department of Pediatrics Vagelos College of Physicians and Surgeons Columbia University New York NY USA
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Affiliation(s)
- Matthew A Rysavy
- Stead Family Department of Pediatrics, University of Iowa, Iowa City
| | - Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Montefiore Medical Center, Bronx, New York
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Nayak B, Moon JY, Kim M, Fischhoff B, Haward MF. Optimism bias in understanding neonatal prognoses. J Perinatol 2021; 41:445-452. [PMID: 32778685 DOI: 10.1038/s41372-020-00773-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Discrepancies between physician and parent neonatal prognostic expectations are common. Optimism bias is a possible explanation. STUDY DESIGN Parents interpreted hypothetical neonatal prognoses in an online survey. RESULTS Good prognoses tended to be interpreted accurately, while poor prognoses were interpreted as less than the stated value. One-third of participants consistently overstated survival for the three lowest prognoses, compared to the sample as a whole. Three significant predictors of such optimistic interpretations were single-parent status (OR 0.39; 95% CI 0.2-0.75; p = 0.005), African-American descent (OR 3.78; 95% CI 1.63-8.98; p = 0.002) and the belief that physicians misrepresented prognoses (OR 3.11; 95% CI 1.47-6.65; p = 0.003). Participants' explanations echoed research on optimism bias in clinical and decision science studies. CONCLUSION Participants accepted positive prognoses for critically ill neonates, but reinterpreted negative ones as being unduly pessimistic demonstrating optimism bias.
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Affiliation(s)
- Babina Nayak
- Harlem Hospital Medical Center, Columbia University, New York, NY, USA.,Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy and Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
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Haward MF, Moore GP, Lantos J, Janvier A. Paediatric ethical issues during the COVID-19 pandemic are not just about ventilator triage. Acta Paediatr 2020; 109:1519-1521. [PMID: 32364256 PMCID: PMC7267437 DOI: 10.1111/apa.15334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Marlyse F. Haward
- Division of Neonatology Department of Pediatrics Children’s Hospital at Montefiore Montefiore Medical Center Albert Einstein College of Medicine Bronx NY USA
| | - Gregory P. Moore
- Division of Neonatology Department of Pediatrics, Children’s Hospital of Eastern Ontario University of Ottawa Ottawa ON Canada
- Division of Newborn Care Department of Obstetrics and Gynecology The Ottawa Hospital General Campus University of Ottawa Ottawa ON Canada
| | - John Lantos
- Department of Pediatrics Children’s Mercy Hospital Kansas City MO USA
| | - Annie Janvier
- Department of Pediatrics, Bureau de l’Éthique Clinique Université de Montréal Montréal QC Canada
- Division of Neonatology, Research Center Clinical Ethics Unit Palliative Care Unit Unité de recherche en éthique clinique et partenariat famille CHU Sainte‐Justine Montréal QC Canada
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Abstract
In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.
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Affiliation(s)
| | | | | | | | - Jessica T Fry
- Ann & Robert H. Lurie Children's Hospital of Chicago
- Northwestern University Feinberg School of Medicine
| | - John Lantos
- Children's Mercy Bioethics Center
- Children's Mercy Hospital
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Abstract
Parenting in the NICU is an intense journey. Parents struggle to build intimacy with their child amid complex emotions and medical uncertainties. They need to rapidly adapt their vision of parenthood to the realities of intensive care. The psychological impact of this journey can have important effects on their psychological health. For parents of sick older children, "good parent" beliefs have been shown to foster positive growth. This concept is also essential for parents of infants in the NICU, although their path is complex.We write as clinicians who were also families in the NICU. We suggest parents need to hear and internalize 3 important messages that overlap but are each important: you are a parent, you are not a bad parent, and you are a good parent. We offer practical suggestions to NICU clinicians that we believe will help NICU parents cope while their infant is in the NICU and afterward.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Montefiore Medical Center, Bronx, New York
| | - John Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montreal, Canada; and .,Clinical Ethics Unit, Palliative Care Unit, and Unité de Recherche en Èthique Clinique et Partenariat Famille, Division of Neonatology, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
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Abstract
BACKGROUND It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. METHODS Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. RESULTS Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, and a combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future "decisional regret" for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. CONCLUSIONS Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation.
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Affiliation(s)
- Marlyse F Haward
- a Children's Hospital at Montefiore, Albert Einstein College of Medicine
| | - Annie Janvier
- b Department of Pediatrics and Clinical Ethics , Université de Montréal, Division of Neonatology, Hôpital Sainte-Justine, Bureau de L'éthique Clinique, Université de Montréal, and Centre de Recherche, Hôpital Sainte-Justine
| | - John M Lorenz
- c Department of Pediatrics , Columbia University College of Physicians and Surgeons, and Morgan Stanley Children's Hospital of New York
| | - Baruch Fischhoff
- d Department of Engineering and Public Policy and Institute for Politics and Strategy , Carnegie Mellon University
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Haward MF, Gaucher N, Payot A, Robson K, Janvier A. Personalized Decision Making: Practical Recommendations for Antenatal Counseling for Fragile Neonates. Clin Perinatol 2017; 44:429-445. [PMID: 28477670 DOI: 10.1016/j.clp.2017.01.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, New York, NY 10467, USA
| | - Nathalie Gaucher
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada
| | - Antoine Payot
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada
| | - Kate Robson
- Canadian Premature Babies Foundation, Toronto, Ontario M4N 3M5, Canada
| | - Annie Janvier
- Department of Pediatrics, CHU Sainte-Justine Research Center, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T 1J4, Canada; Clinical Ethics Unit, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec H3T-1C5, Canada; Palliative Care Unit, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Unité d'Éthique Clinique et de Partenariat Famille, Sainte-Justine Hospital, Montreal, Quebec H3T-1C5, Canada; Department of Pediatrics and Clinical Ethics, Sainte-Justine Hospital, University of Montreal, 3175 Chemin Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
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Haward MF, Janvier A. An introduction to behavioural decision-making theories for paediatricians. Acta Paediatr 2015; 104:340-5. [PMID: 25625319 DOI: 10.1111/apa.12948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/02/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. CONCLUSION As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making.
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Affiliation(s)
- Marlyse F. Haward
- Department of Paediatrics; Albert Einstein College of Medicine; Children's Hospital at Montefiore; Bronx NY USA
- Division of Neonatology; The Valley Hospital; Ridgewood NJ USA
| | - Annie Janvier
- Department of Paediatrics and Clinical Ethics; Université de Montréal; Montreal QC Canada
- Neonatology and Clinical Ethics; Hôpital Sainte-Justine Montreal; Montreal QC Canada
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Abstract
OBJECTIVE To examine whether parents' delivery room management decisions for extremely preterm infants are influenced by (1) the degree of detail with which options (comfort care [CC] or intensive care [IC]) are presented or (2) their order of presentation. METHODS A total of 309 volunteers, 18 to 55 years old, were each randomized to 1 of 4 groups: (1) detailed descriptions, CC presented first; (2) detailed descriptions, IC presented first; (3) brief descriptions, CC presented first; or (4) brief descriptions, IC presented first. Each received the description of a hypothetical delivery of a 23-week gestation infant and chose either IC or CC. Open-ended and structured questions elicited reasoning. Data were analyzed by χ(2) and logistic regression analysis. RESULTS Neither degree of detail, comparing groups 1+2 with 3+4 (37% vs 41%, odds ratio = 0.85, 95% confidence interval = 0.54-1.34, P = .48), nor order, comparing groups 1+3 with 2+4 (40% vs 37%, odds ratio = 0.88, 95% confidence interval = 0.56-1.39; P = .59), influenced the likelihood of choosing IC. Participants choosing IC were more likely to invoke sanctity of life and religiosity as personal values. Additional reasons for choosing IC were experiences with infants born at later gestational ages, giving the infant a chance, not watching their infant die, and equating CC with euthanasia. Some choosing CC wanted to avoid infant suffering. CONCLUSIONS The degree of detail and order of presentation had no effect on treatment decisions, suggesting that individuals bring well-articulated preexisting preferences to such decisions. Understanding beliefs and attitudes motivating these preferences can assist physicians in helping parents make informed decisions consistent with their values.
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Affiliation(s)
- Marlyse F Haward
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Abstract
Decision-making for extremely immature preterm infants at the margins of viability is ethically, professionally, and emotionally complicated. A standard for prenatal consultation should be developed incorporating assessment of parental decision-making preferences and styles, a communication process involving a reciprocal exchange of information, and effective strategies for decisional deliberation, guided by and consistent with parental moral framework. Professional caregivers providing perinatal consultations or end-of-life counseling for extremely preterm infants should be sensitive to these issues and be taught flexibility in counseling techniques adhering to consistent guidelines. Emphasis must shift away from physician beliefs and behaviors about the boundaries of viability.
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Affiliation(s)
- Marlyse F Haward
- Division of Neonatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10461, USA.
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Affiliation(s)
- Marlyse F Haward
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA.
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Abstract
OBJECTIVES The purpose of this study was to explore the effect of information framing on parental decisions about resuscitation of extremely premature infants. Secondary outcomes focused on elucidating the impact of other variables on treatment choices and determining whether those effects would take precedence over any framing effects. METHODS This confidential survey study was administered to adult volunteers via the Internet. The surveys depicted a hypothetical vignette of a threatened delivery at gestational age of 23 weeks, with prognostic outcome information framed as either survival with lack of disability (positive frame) or chance of dying and likelihood of disability among survivors (negative frame). Participants were randomly assigned to receive either the positively or negatively framed vignette. They were then asked to choose whether they would prefer resuscitation or comfort care. After completing the survey vignette, participants were directed to a questionnaire designed to test the secondary hypothesis and to explore possible factors associated with treatment decisions. RESULTS A total of 146 subjects received prognostic information framed as survival data and 146 subjects received prognostic information framed as mortality data. Overall, 24% of the sample population chose comfort care and 76% chose resuscitation. A strong trend was detected toward a framing effect on treatment preference; respondents for whom prognosis was framed as survival data were more likely to elect resuscitation. This framing effect was significant in a multivariate analysis controlling for religiousness, parental status, and beliefs regarding the sanctity of life. Of these covariates, only religiousness modified susceptibility to framing; participants who were not highly religious were significantly more likely to be influenced to opt for resuscitation by the positive frame than were participants who were highly religious. CONCLUSIONS Framing bias may compromise efforts to approach prenatal counseling in a nondirective manner. This is especially true for subsets of participants who are not highly religious.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, USA.
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Wu YW, Hamrick SEG, Miller SP, Haward MF, Lai MC, Callen PW, Barkovich AJ, Ferriero DM. Intraventricular hemorrhage in term neonates caused by sinovenous thrombosis. Ann Neurol 2003; 54:123-6. [PMID: 12838529 DOI: 10.1002/ana.10619] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The cause of intraventricular hemorrhage in term neonates is poorly understood. Among 29 neonates of at least 36 weeks' gestation with intraventricular hemorrhage, 9 (31%) had cerebral sinovenous thrombosis. Of the 26 neonates who underwent computed tomography or magnetic resonance studies, those with thalamic hemorrhage were more likely to have sinovenous thrombosis than those without thalamic involvement (4/5 vs 5/21, p = 0.03). Term neonates with intraventricular hemorrhage should undergo neuroimaging to evaluate the presence of sinovenous thrombosis. Ann Neurol 2003
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Affiliation(s)
- Yvonne W Wu
- Department of Neurology, University of California, San Francisco, CA 94143-0136, USA.
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