PS 4-14 PARENTS' PERSPECTIVES ON ANTENATAL DECISION MAKING FOR THE ANTICIPATED BIRTH OF A PERIVIABLE INFANT

Wednesday, October 26, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 4-14

Brownsyne Tucker Edmonds, MD, MPH, MS, Indiana University School of Medicine, Indianapolis, IN, Teresa Savage, PhD, RN, University of Illinois at Chicago College of Nursing, Chicago, IL, Robert Kimura, MD, Rush Medical College, Chicago, IL, Sarah Kilpatrick, MD, PhD, 4Cedars-Sinai Medical Center, Los Angeles, CA, Miriam Kuppermann, PhD, MPH, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, William Grobman, MD, MBA, Northwestern University Feinberg School of Medicine, Chicago, IL and Karen Kavanaugh, PhD, RN, FAAN, Wayne State University College of Nursing, Detroit, MI
Purpose: To examine parents’ perceptions of management options and outcomes, and the values they apply in making antenatal decisions regarding periviable birth.

Method: We conducted a qualitative analysis of 46 antenatal semi-structured interviews conducted at three tertiary-care hospitals with 54 parents (40 mothers, 14 fathers) admitted to labor and delivery with threatened periviable delivery.

Result: Participants most often recalled being involved in resuscitation, cerclage and delivery mode decisions. The majority (34) desired a shared decision-making role.  Most (46) recalled hearing about morbidity and mortality, with many reiterating terms like “brain damage,” “disability,” and “handicap.” In describing what mattered most, several (12) spoke of giving their child a “fighting chance;” others voiced concerns about “best interest,” a “healthy baby,” “pain and suffering,” and religious faith. The potential for disability influenced decision making to variable degrees.

Conclusion: As parents and professional organizations call for shared decision-making in periviable care, interventions are needed to facilitate models of counseling that are both informed, deliberative, and attentive to parents’ values.  Our findings suggest that parents can retain basic concepts—if not specific statistics—about long-term morbidity.  And importantly, parents place varying degrees of importance on the potential for disability in their decision-making.  These findings should caution providers about making assumptions about parental values and preferences, and underscore the importance of eliciting values and preferences to clarify the factors that parents deem most important in their decision-making.

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