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Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study.
BMC Medical Ethics ( IF 3.0 ) Pub Date : 2019-10-22 , DOI: 10.1186/s12910-019-0413-7
V Papadimitriou 1 , B Tosello 1, 2 , R Pfister 1
Affiliation  

BACKGROUND Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received. METHODS This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals. RESULTS Forty-nine responders (48%) were students (response rate of 33.1%), 32 (31%) paediatricians (response rate of 91.4%) and 21 (20%) nurses in NICU (response rate of 50%). The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of "survival without disability" at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages. CONCLUSION Written information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow.

中文翻译:

书面结果信息对围产期卫生保健专业人员在生存能力极限下的态度的影响:一项随机研究。

背景技术父母和专业人士在生存能力极限方面对复苏态度的看法和潜在分歧存在差异。这项研究在医疗保健专业人员中评估了是否在生存能力极限(重症监护与舒适性监护)下进行复苏的决定是否受到有关已发生风险的信息的提供或接收方式的影响。方法这是一项前瞻性随机对照研究。这项研究通过测试乐观地或悲观地绘制的图形事实表所给出的信息的效果,评估了医疗保健专业人员的态度。书面教育概况介绍包括按胎龄划分的三个存活率和并发症/发病率的图形表示。问卷是在4个月内向日内瓦大学的5至6年级医学生以及日内瓦大学医院新生儿科的医生和护士提交的。我们的样本包括102名医疗保健专业人员。结果在重症监护病房中,有49名响应者(48%)是学生(响应率为33.1%),32名(31%)儿科医生(响应率为91.4%)和21名(20%)护士。与乐观的陈述相比,在23至25周时,乐观的看法更倾向于“无残障生存”的观念,因此,与以图形方式呈现的事实和当前指南相比,两组的接受风险往往更为严重。两组之间的治疗态度没有差异,但是在非常低的胎龄时,带孩子的医疗保健专业人员会受到更大的限制,学生的攻击性会更高。结论以图形形式提供给医疗保健专业人员的有关死亡率和发病率的书面信息鼓励他们高估风险。但是,在咨询过程中,医护人员的知觉可能无法直接转换为父母的知觉,因为后者通常对所接收的数据不敏感。始终以巧妙地塑造后续决定的方式传达这种父母信息。在咨询过程中,医护人员的知觉可能无法直接转换为父母的知觉,因为后者通常对于所接收的数据而言是幼稚的。始终以巧妙地塑造后续决定的方式传达这种父母信息。在咨询过程中,医护人员的知觉可能无法直接转换为父母的知觉,因为后者通常对于所接收的数据而言是幼稚的。始终以巧妙地塑造后续决定的方式传达这种父母信息。
更新日期:2019-10-22
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