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Antenatal consultation and deliberation: adapting to parental preferences

Journal of Perinatology volume 43, pages 895–902 (2023)Cite this article

Subjects

Abstract

Objective

To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts.

Study design

Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience.

Results

Non-clinician participants’ (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who – parent or clinician – should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents’ would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently.

Conclusions

Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.

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Acknowledgements

We thank Rosie Ferrara, Sandra Sandve for additional help with transcriptions. The authors are grateful for the participants in these interviews, who shared their views and experiences with us on these difficult topics.

Funding

Marron-Manginello Endowment of the Valley Hospital Foundation and Division of Neonatology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA

    Marlyse F. Haward

  2. Department of Pediatrics, Morgan Stanley Children Hospital of New York and Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA

    John M. Lorenz

  3. Department of Pediatrics, Bureau de l’Éthique Clinique, Université de Montréal and Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, QC, Canada

    Annie Janvier

  4. Institute for Politics and Strategy, and Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA

    Baruch Fischhoff

Authors
  1. Marlyse F. Haward
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  3. Annie Janvier
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  4. Baruch Fischhoff
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Contributions

All authors participated equally in the following: 1- conceived and designed the work that led to the submission, acquired data, and played an important role in interpreting the results 2- Drafted or revised the manuscript. 3- Approved the final version.4- Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Marlyse F. Haward.

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The authors declare no competing interests.

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Haward, M.F., Lorenz, J.M., Janvier, A. et al. Antenatal consultation and deliberation: adapting to parental preferences. J Perinatol 43, 895–902 (2023). https://doi.org/10.1038/s41372-023-01605-8

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