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AJOB Primary Research.

A pilot study of neonatologists’ decision-making roles in delivery room resuscitation counseling for periviable births

Background: Relatively little is known about neonatologists’ roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the “decision-making role” of neonatologists in simulated periviable counseling sessions. Methods: We conducted a qualitative content analysis of audio-recorded simulation encounters and postencounter debriefing interviews collected as part of a single-center simulation study of neonatologists’ resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded postsimulation debriefing interviews for responses to the open-ended prompt: “During this encounter, what did you feel was your role in the management decision-making process?” Results: Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient’s values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. Conclusions: Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations—even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice.

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Volume 7, Issue 3
July 2016

Target Articles.

Improving third-year medical students' competency in clinical moral reasoning: Two interventions Paul J. Cummins, Katherine J. Mendis, Robert Fallar, Amanda Favia, Lily Frank, Carolyn Plunkett, Nada Gligorov & Rosamond Rhodes
Religious identity and workplace discrimination: A national survey of American Muslim physicians Aasim I. Padela, Huda Adam, Maha Ahmad, Zahra Hosseinian & Farr Curlin
A pilot study of neonatologists' decision-making roles in delivery room resuscitation counseling for periviable births Brownsyne Tucker Edmonds, Fatima McKenzie, Janet E. Panoch, Douglas B. White & Amber E. Barnato
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Concerns about genetic testing for schizophrenia among young adults at clinical high risk for psychosis Ryan E. Lawrence, Phoebe Friesen, Gary Brucato, Ragy R. Girgis & Lisa Dixon