DO NEONATOLOGISTS AND NURSES DIFFER IN THEIR PREFERENCES FOR OUTCOMES OF NEONATAL INTENSIVE CARE? † 1652

Background: Medical decisions made in the immediate neonatal period may have complex ethical, social and economic implications. Yet, little information is available on the differences in preferences (utilities) among health professionals for the resulting health outcomes. Objectives: To measure and to compare preferences for selected health states from the perspective of neonatologists/pediatricians and NICU nurses. Design: The Standard Gamble technique (Chance Board) which offers a lottery approach with varying probabilities was used to measure preferences under conditions of uncertainty; this approach yields a single cardinal utility score between -1.0 and 1.0, where -1.0 is the maximum amount a health state is allowed to be worse than death; 0 = dead and 1.0 = perfect health. Professional interviewers presented respondents with 5 preselected hypothetical health scenarios of varying severity to estimate the health-related quality of life (HRQL) of each health state. Setting: Physicians: Within commuting distance, plus those attending a Canadian Pediatric conference; Nurses: A random sample from 3 tertiary-care NICUs in Ontario. Participants: Physicians: 87/130(67%) registered neonatologists in Canada and 13 pediatricians practising level II neonatal care; Nurses: n = 103. Results: Overall, nurses and physicians had similar preferences for the health states (F 3.3, p = 0.07); 60% physicians and 68% nurses rated at least one of the health states to be worse than death (p = 0.3). The individual HRQL scores (mean, SD) were:Table Conclusions: HRQL rankings by health professionals were consistent with the severity of the health states. Both groups rated the two worst health scenarios (“Pat” and“Sandy”) extremely low, with mean scores near zero or below. Contrary to our hypothesis and the literature, no statistically significant differences were observed between the HRQL ratings provided by physicians and nurses. This consistency in valuation of HRQL by health care providers working as a team in the NICU is reassuring.

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