Loading…

Shared decision making for infants born at the threshold of viability: a prognosis-based guideline

Objective: Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline. Study Design: We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appr...

Full description

Saved in:
Bibliographic Details
Published in:Journal of perinatology 2016-07, Vol.36 (7), p.503-509
Main Authors: Lemyre, B, Daboval, T, Dunn, S, Kekewich, M, Jones, G, Wang, D, Mason-Ward, M, Moore, G P
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective: Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline. Study Design: We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appraisal of published guidelines; (2) identification of key medical factors for decision making; (3) systematic reviews; (4) creation of a multi-disciplinary working group and (5) external consultation and appraisal. Result: No published guideline met high-quality appraisal criteria. Survival, neurodevelopmental disability, quality of life of child and parents, and maternal mortality and risk of long-term morbidity were identified as key for quality decision-making. Eighteen stakeholders (including parents) advocated for the incorporation of parents’ values and preferences in the process. Conclusion: A novel framework, based on prognosis, was generated to guide when early intensive and palliative care may both be offered to expectant parents. Pre-implementation assessment is underway to identify barriers and facilitators to putting in practice.
ISSN:0743-8346
1476-5543
DOI:10.1038/jp.2016.81