Effect of an Educational Presentation about Extremely Preterm Infants on Knowledge and Attitudes of Health Care Providers

Stefani Doucette; Brigitte Lemyre; Thierry Daboval; Sandra Dunn; Salwa Akiki; Nick Barrowman; Gregory P. Moore

doi:10.1055/s-0037-1601308

American Journal of Perinatology, Table of Contents

Am J Perinatol 2017; 34(10): 0982-0989
DOI: 10.1055/s-0037-1601308

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of an Educational Presentation about Extremely Preterm Infants on Knowledge and Attitudes of Health Care Providers

Stefani Doucette

¹Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

,

Brigitte Lemyre

¹Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

²Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

³Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Thierry Daboval

¹Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

²Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

³Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada

,

Sandra Dunn

⁴Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

⁵Better Outcomes Registry and Network Ontario, Ontario, Canada

,

Salwa Akiki

⁴Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

,

Nick Barrowman

⁴Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada

,

Gregory P. Moore

¹Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

²Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

³Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada

› Author Affiliations

Abstract

Objective To determine healthcare providers' knowledge (HCP) about survival rates of extremely preterm infants (EPI) and attitudes toward resuscitation before and after an educational presentation and, to examine the relationship between knowledge and attitudes toward resuscitation.

Study Design Participants completed a survey before and after attending a presentation detailing evidence-based estimates of survival rates and surrounding ethical issues. Respondents included neonatologists, obstetricians, pediatricians, maternal-fetal medicine specialists, trainees in pediatrics, obstetrics, neonatal-perinatal medicine and neonatal and obstetrical nurses.

Results In total, 166 participants attended an educational presentation and 130 participants completed both pre- and postsurveys (response rate 78%). Prepresentation, for all gestations, ≤ 50% of respondents correctly identified survival/intact survival rates. Postpresentation, correct responses regarding survival/intact survival rates ranged from 49 to 86% (p < 0.001) and attitudes shifted toward being more likely to resuscitate at all gestations regardless of parental wishes. There was a weak-to-modest relationship (Spearman's coefficient 0.24–0.40, p < 0.001–0.004) between knowledge responses and attitudes.

Conclusion Attendance at an educational presentation did improve HCP knowledge about survival and long term outcomes for EPI, but HCP still underestimated survival and were not always willing to resuscitate in accordance with parental wishes. These findings may represent barriers to some experts' recommendation to use shared decision-making with parents when considering the resuscitation options for their EPI.

Keywords

knowledge - attitudes - educational - survival - resuscitation - extremely preterm infant

Full Text

References

References
1 Raju TN, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34 (05) 333-342
2 Lantos JD, Meadow W. Variation in the treatment of infants born at the borderline of viability. Pediatrics 2009; 123 (06) 1588-1590
3 Singh J, Fanaroff J, Andrews B. , et al. Resuscitation in the “gray zone” of viability: determining physician preferences and predicting infant outcomes. Pediatrics 2007; 120 (03) 519-526
4 Rysavy MA, Li L, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
5 Canadian Neonatal Network. Annual Reports for 2005–2013. Available at: http://www.canadianneonatalnetwork.org . Accessed August 17, 2016
6 Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M. ; Neonatal Research Network, Japan. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013; 132 (01) 62-71
7 Doyle LW, Roberts G, Anderson PJ. ; Victorian Infant Collaborative Study Group. Changing long-term outcomes for infants 500-999 g birth weight in Victoria, 1979-2005. Arch Dis Child Fetal Neonatal Ed 2011; 96 (06) F443-F447
8 Guillen U, DeMauro S, Ma L. , et al. Survival rates in extremely low birthweight infants depend on the denominator: avoiding potential for bias by specifying denominators. Am J Obstet Gynecol 2011; 205 (04) 329.e1-329.e7
9 Behrman RE, Stith BA. Preterm Birth: Causes, Consequences and Prevention. Washignton, DC: National Academy of Sciences; 2008
10 Moore GP, Lemyre B, Barrowman N, Daboval T. Neurodevelopmental outcomes at 4 to 8 years of children born at 22 to 25 weeks' gestational age: a meta-analysis. JAMA Pediatr 2013; 167 (10) 967-974
11 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity--moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
12 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44 (05) 681-692
13 Blanco F, Suresh G, Howard D, Soll RF. Ensuring accurate knowledge of prematurity outcomes for prenatal counseling. Pediatrics 2005; 115 (04) e478-e487
14 Morse SB, Haywood JL, Goldenberg RL, Bronstein J, Nelson KG, Carlo WA. Estimation of neonatal outcome and perinatal therapy use. Pediatrics 2000; 105 (05) 1046-1050
15 Oei J, Askie LM, Tobiansky R, Lui K. Attitudes of neonatal clinicians towards resuscitation of the extremely premature infant: an exploratory survey. J Paediatr Child Health 2000; 36 (04) 357-362
16 Lavoie PM, Keidar Y, Albersheim S. Attitudes of Canadian neonatologists in delivery room resuscitation of newborns at threshold of viability. J Obstet Gynaecol Can 2007; 29 (09) 719-725
17 Streiner DL, Saigal S, Burrows E, Stoskopf B, Rosenbaum P. Attitudes of parents and health care professionals toward active treatment of extremely premature infants. Pediatrics 2001; 108 (01) 152-157
18 Albersheim SG, Lavoie PM, Keidar YD. Do neonatologists limit parental decision-making authority? A Canadian perspective. Early Hum Dev 2010; 86 (12) 801-805
19 Håkansson S, Farooqi A, Holmgren PA, Serenius F, Högberg U. Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics 2004; 114 (01) 58-64
20 Cummings J. ; COMMITTEE ON FETUS AND NEWBORN. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics 2015; 136 (03) 588-595
21 Jefferies AL, Kirpalani HM. ; Canadian Paediatric Society Fetus and Newborn Committee. Counselling and management for anticipated extremely preterm birth. Paediatr Child Health 2012; 17 (08) 443-446
22 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. ACOG Obstetric Care Consensus No. 3: Periviable Birth. Obstet Gynecol 2015; 126 (05) e82-94
23 Bastek TK, Richardson DK, Zupancic JA, Burns JP. Prenatal consultation practices at the border of viability: a regional survey. Pediatrics 2005; 116 (02) 407-413
24 Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. ; “Psychological Theory” Group. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005; 14 (01) 26-33
25 Nguyen TP, Amon E, Al-Hosni M, Gavard JA, Gross G, Myles TD. “Early” versus “late” 23-week infant outcomes. Am J Obstet Gynecol 2012; 207 (03) 226.e1-226.e6
26 Shah PS, Ye XY, Synnes A, Rouvinez-Bouali N, Yee W, Lee SK. ; Canadian Neonatal Network. Prediction of survival without morbidity for infants born at under 33 weeks gestational age: a user-friendly graphical tool. Arch Dis Child Fetal Neonatal Ed 2012; 97 (02) F110-F115
27 Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF. ; Trial of Indomethacin Prophylaxis in Preterms (TIPP) Investigators. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289 (09) 1124-1129
28 Saigal S, Feeny D, Rosenbaum P, Furlong W, Burrows E, Stoskopf B. Self-perceived health status and health-related quality of life of extremely low-birth-weight infants at adolescence. JAMA 1996; 276 (06) 453-459
29 Roberts G, Burnett AC, Lee KJ. , et al; Victorian Infant Collaborative Study Group. Quality of life at age 18 years after extremely preterm birth in the post-surfactant era. J Pediatr 2013; 163 (04) 1008-13.e1
30 Saigal S, Stoskopf BL, Feeny D. , et al. Informed decisions for extremely low-birth-weight infants. JAMA 2000; 283 (24) 3201-3202
31 Wilkinson DJ. Gestational ageism. Arch Pediatr Adolesc Med 2012; 166 (06) 567-572
32 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
33 Nguyen YL, Wunsch H, Angus DC. Critical care: the impact of organization and management on outcomes. Curr Opin Crit Care 2010; 16 (05) 487-492
34 Guillén Ú, Weiss EM, Munson D. , et al. Guidelines for the management of extremely premature deliveries: a systematic review. Pediatrics 2015; 136 (02) 343-350
35 Health Behavior and Health Education: Theory, research and practice website. Available at: http://www.med.upenn.edu/hbhe4/part2-ch4-integrated-behavior-model.shtml . Accessed August 17, 2016
36 Barry MJ, Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care. N Engl J Med 2012; 366 (09) 780-781
37 Ubel PA. Medical facts versus value judgements – toward preference-sensitive guidelines. N Engl J Med 2015; 372 (26) 2475-2477

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