Comparing neonatal morbidity and mortality estimates across specialty in periviable counseling

• Published in: The journal of maternal-fetal & neonatal medicine 2015-12, Vol.28 (18), p.2145-2149
• Main Authors: Tucker Edmonds, Brownsyne, McKenzie, Fatima, Panoch, Janet E., Frankel, Richard M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical Competence - statistics & numerical data; Counseling - methods; Counseling - standards; Doctor-patient communication; extreme prematurity; Female; Fetal Membranes, Premature Rupture; Fetal Viability; Humans; Indiana; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - etiology; Male; Middle Aged; Neonatology; Obstetrics; Patient Simulation; periviability; Physician-Patient Relations; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy; Prenatal Care - methods; Prenatal Care - standards; Risk Assessment; risk-communication; Truth Disclosure
• ISSN: 1476-7058; 1476-4954
• DOI: 10.3109/14767058.2014.981807

Objective: To describe and compare estimates of neonatal morbidity and mortality communicated by neonatologists and obstetricians in simulated periviable counseling encounters. Methods: A simulation-based study of 16 obstetricians (OBs) and 15 neonatologists counseling standardized patients portraying pregnant women with ruptured membranes at 23 weeks gestation. Two investigators tabulated all instances of numerically-described risk estimates across individuals and by specialty. Results: Overall, 12/15 (80%) neonatologists utilized numeric estimates of survival; 6/16 (38%) OBs did. OBs frequently deferred the discussion of "exact numbers" to neonatologists. The 12 neonatologists provided 13 unique numeric estimates, ranging from 3% to 50% survival. Half of those neonatologists provided two to three different estimates in a single encounter. By comparison, six OBs provided four unique survival estimates ("50%", "30-40%", "1/3-1/2", "