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Klin Padiatr
DOI: 10.1055/a-2480-9686
Original Article

Would Neonatal Healthcare Professionals Disclose Personal Opinions When Counseling Parents About Value-laden Decisions?

Würden Fachkräfte der Neonatologie ihre persönliche Meinung offenlegen, wenn sie Eltern zu wertebasierten Entscheidungen beraten?
Christine Arnold 
1   Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Julian Eychmüller
1   Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Dina Hediger
2   Swiss non-profit organization of parents of preterm born children, Frühchen Schweiz, Bern, Switzerland
,
Lukas Baumann
1   Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Sophie Jaisli
1   Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
André Kidszun
1   Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract

Background To explore the attitudes of neonatal healthcare professionals towards disclosing personal opinions when counseling parents about value-laden decisions using scripted video animations, with a view to comparing these later with the attitudes of parents of preterm infants.

Methods An exploratory study was conducted during the 5th Annual Meeting of the Joint European Neonatal Societies in Rome. Data were collected via a web-based survey during a live session. Two scripted video animations were presented and discussed, one with and one without disclosure of the physician’s personal opinion.

Results Sixty-nine healthcare professionals from 19 countries were enrolled. Forty-seven (68.1%) respondents stated that disclosing personal opinions would “unduly influence” the parents' decision-making process. Thirty-seven (53.6%) participants would not have given their personal opinion in the case presented, and 45 (65.2%) participants stated that disclosure of the physician's personal opinion would result in parents being less prepared for decision-making. Discussions were dominated by underlying values and culture rather than the process of sharing opinions.

Discussion and Conclusions The study provides new insights into the opinions of healthcare professionals on the disclosure of personal opinions when making difficult treatment decisions, but further research may require a more nuanced approach in different scenarios. Further research with a larger sample and different scenarios is needed to explore in more depth healthcare professionals’ and parents’ attitudes of autonomous decision-making.

Zusammenfassung

Hintergrund Ziel war die Untersuchung von Einstellungen von Fachkräften der Neonatologie gegenüber der Offenlegung persönlicher Meinungen in wertbasierten Beratungen über schwierige Therapieentscheidungen, um sie später mit der Einstellungen der Eltern von Frühgeborenen zu vergleichen.

Methoden Eine explorative Studie wurde während der 5. Jahrestagung der Joint European Neonatal Societies in Rom durchgeführt. Die Daten wurden mittels einer webbasierten Umfrage während einer Session erhoben. Es wurden zwei Videoanimationen präsentiert und diskutiert, eine mit und eine ohne Offenlegung der persönlichen Meinung der Ärztin.

Ergebnisse 69 Fachkräfte der Neonatologie aus 19 Ländern nahmen an der Umfrage teil. 47 (68,1%) der Befragten gaben an, dass die Offenlegung der persönlichen Meinung den Entscheidungsprozess der Eltern unangemessen beeinflussen würde. 37 (53,6%) Teilnehmende hätten in dem vorliegenden Fall ihre persönliche Meinung nicht geäußert, und 45 (65,2%) Teilnehmende gaben an, dass die Offenlegung der persönlichen Meinung der Ärztin dazu führen würde, dass die Eltern weniger gut auf die Entscheidungsfindung vorbereitet wären. Die Diskussion in der Session wurde eher durch die zugrundeliegenden Werte und die Kultur als durch den Prozess der Meinungsäußerung dominiert.

Diskussion und Schlussfolgerungen Die Studie liefert erste Einblicke in die Meinung von Fachkräften der Neonatologie zur Offenlegung persönlicher Meinungen bei schwierigen Therapieentscheidungen, aber weitere Untersuchungen mit einer größeren Stichprobe und unterschiedlichen Szenarien sind erforderlich, um die Einstellung der Fachkräfte des Gesundheitswesens und der Eltern zur autonomen Entscheidungsfindung tiefgründiger zu untersuchen.

Keywords

disclosing personal opinions - value-laden decisions - parents - healthcare professionals - scripted video animation

Schlüsselwörter

Offenlegung persönlicher Meinungen - wertebasierte Entscheidungen - Eltern - Gesundheitspersonal - animiertes Fallbeispiel

Supplementary Material



Publication History

Article published online:
27 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Lantos JD. Ethical Problems in Decision Making in the Neonatal ICU. N Engl J Med 2018; 379: 1851-1860
    CrossrefPubMedSearch in Google Scholar
  • 2 Kon AA. Answering the question: “Doctor, if this were your child, what would you do?”. Pediatrics 2006; 118: 393-397
    CrossrefPubMedSearch in Google Scholar
  • 3 Caeymaex L, Speranza M, Vasilescu C. et al. Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU. PLoS One 2011; 6: e28633
    CrossrefPubMedSearch in Google Scholar
  • 4 Tucker Edmonds B, McKenzie F, Panoch JE. et al. “Doctor, what would you do?”: physicians’ responses to patient inquiries about periviable delivery. Patient Educ Couns 2015; 98: 49-54
    CrossrefPubMedSearch in Google Scholar
  • 5 Sullivan A, Cummings C. Historical Perspectives: Shared Decision Making in the NICU. Neoreviews 2020; 21: e217-e225
    CrossrefPubMedSearch in Google Scholar
  • 6 McHaffie HE, Laing IA, Parker M. et al. Deciding for imperiled newborns: medical authority or parental autonomy?. J Med Ethics 2001; 27: 104-109
    CrossrefPubMedSearch in Google Scholar
  • 7 Walter JK, Ross LF. Relational autonomy: moving beyond the limits of isolated individualism. Pediatrics. 2014; 133: S16-S23
    CrossrefPubMedSearch in Google Scholar
  • 8 Blumenthal-Barby JS, Loftis L, Cummings CL. et al. Should Neonatologists Give Opinions Withdrawing Life-sustaining Treatment?. Pediatrics 2016; 138: e20162585
    CrossrefPubMedSearch in Google Scholar
  • 9 Baylis F, Downie J. Professional recommendations: disclosing facts and values. J Med Ethics 2001; 27: 20-24
    CrossrefPubMedSearch in Google Scholar
  • 10 Ubel PA. “What should I do, doc?”: Some psychologic benefits of physician recommendations. Arch Intern Med 2002; 162: 977-980
    CrossrefPubMedSearch in Google Scholar
  • 11 Kavanaugh K, Savage T, Kilpatrick S. et al. Life support decisions for extremely premature infants: report of a pilot study. J Pediatr Nurs 2005; 20: 347-359
    CrossrefPubMedSearch in Google Scholar
  • 12 Hillen MA, van Vliet LM, de Haes HC. et al. Developing and administering scripted video vignettes for experimental research of patient-provider communication. Patient Educ Couns 2013; 91: 295-309
    CrossrefPubMedSearch in Google Scholar
  • 13 Cox C, Hatfield T, Moxey J. et al. Creating and administering video vignettes for a study examining the communication of diagnostic uncertainty: methodological insights to improve accessibility for researchers and participants. BMC Med Res Methodol 2023; 23: 296
    CrossrefPubMedSearch in Google Scholar
  • 14 Tucker Edmonds B, Torke AM, Helft P. et al. Doctor, What Would You Do? An ANSWER for Patients Requesting Advice About Value-Laden Decisions. Pediatrics. 2015; 136: 740-745
    CrossrefPubMedSearch in Google Scholar
  • 15 Bomhof-Roordink H, Gärtner FR, Stiggelbout AM. et al. Key components of shared decision making models: a systematic review. BMJ Open 2019; 9: e031763
    CrossrefPubMedSearch in Google Scholar
  • 16 Mackenzie C, Stoljar N. Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. Oxford University Press; 2000
    CrossrefSearch in Google Scholar
  • 17 Arnold C, Inthorn J, Roth B. et al. Attitudes and values towards decisions at the margin of viability among expectant mothers at risk for preterm birth. Acta Paediatr 2024; 113: 442-448
    CrossrefPubMedSearch in Google Scholar
  • 18 Minkoff H, Lyerly AD. Doctor, what would you do?. Obstetrics & Gynecology 2009; 113: 1137-1139
    CrossrefPubMedSearch in Google Scholar
  • 19 Kon AA. Assessment of physician directiveness: using hypoplastic left heart syndrome as a model. J Perinatol 2004; 24: 500-504
    CrossrefPubMedSearch in Google Scholar
  • 20 Demyan L, Siskind S, Harmon L. et al. Do It to Them, Not to Me: Doctors' and Nurses' Personal Preferences Versus Recommendations for End-of-Life Care. J Surg Res 2021; 264: 76-80
    CrossrefPubMedSearch in Google Scholar
  • 21 Bucher HU, Klein SD, Hendriks MJ. et al. Correction to: decision-making at the limit of viability: differing perceptions and opinions between neonatal physicians and nurses. BMC Pediatr 2018; 18: 226
    CrossrefPubMedSearch in Google Scholar