USING CONJOINT ANALYSIS TO ASSESS THE RELATIVE INFLUENCE OF RESUSCITATION PREFERENCES ON OBSTETRICAL MANAGEMENT OF PERIVIABLE DELIVERIES
Method: We surveyed 295 obstetrician-gynecologists about management decisions for periviable preterm premature rupture of membranes. Across 9 vignettes, we systematically varied 4 patient characteristics: gestational age (GA; 22/23/24 weeks); occupation (janitor/corporate manager); method of conception (spontaneous/IVF); and patient resuscitation preferences (comfort/resuscitation/undecided). Patient race (black/white) was randomly assigned, varying across, but not within, surveys. Physicians rated their likelihood of proceeding with 4 management decisions (offer induction; order steroids; cesarean for labor; cesarean for distress) from 0 (Definitely would not) to 10 (Definitely would). Data were analyzed via conjoint analysis.
Result: 205 were included in the final analysis. 64.9% of study participants were female; 92.2% Generalists, 4.4% MFM; and 29.8% practiced in the Northeast. Median ratings for each management decision were: induction 1.89; steroids 5.00; cesarean for labor 3.89; cesarean for distress 4.11. Gestational age had the largest influence on physician ratings for all 4 decisions. Parental resuscitation preference was second most important. Provider and practice setting characteristics that influenced decision-making included: age, sex, parenting status, malpractice history, region of practice, and resident supervision (all p<.05).
Conclusion: Our findings suggest that gestational age is weighted more heavily than patients’ resuscitation preferences in obstetricians’ decision-making for periviable delivery management. Given the poor outcomes and value-laden nature of periviable decision-making, patient resuscitation preference should arguably be the primary factor guiding decision-making. Interventions are needed to facilitate shared decision-making and promote patient-centered periviable care.