Robert Wood Johnson Foundation Clinical Scholars program, the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
Am J Obstet Gynecol. 2012 Mar;206(3):248.e1-5. doi: 10.1016/j.ajog.2011.11.011.
The purpose of this study was to examine factors that influence obstetric decision-making and counseling for periviable deliveries and to describe counseling challenges.
Twenty-one semistructured interviews were conducted with obstetricians who were recruited from 5 academic medical centers in Philadelphia. Two trained reviewers independently coded transcripts using grounded theory methods. Research software facilitated qualitative analysis.
Circumscribed by institutional norms and clinical acuity, obstetric decision-making and counseling were influenced primarily by patient preferences. Perspectives on patient autonomy guided approaches to counseling. Thresholds for intervention varied from "attending to attending" and "institution to institution." Sociodemographic factors were not believed to influence clinical decision-making. However, obstetricians admittedly managed in vitro fertilization pregnancies more aggressively. Communicating uncertainty, managing expectations, assessing understanding, and relaying consistent messages across specialties were frequently described counseling challenges for obstetricians.
The impact of institutional variation and in vitro fertilization on periviable decision-making warrants further consideration. Interventions to train and support obstetricians in communicating uncertainty, managing expectations, and assessing values and understanding are needed.
本研究旨在探讨影响极早产儿分娩决策和咨询的因素，并描述咨询挑战。
从费城的 5 所学术医疗中心招募了 21 名妇产科医生进行了 21 次半结构化访谈。两名经过培训的评审员使用扎根理论方法独立对转录本进行编码。研究软件促进了定性分析。
受机构规范和临床紧迫性的限制，产科决策和咨询主要受患者偏好的影响。对患者自主权的看法指导了咨询方法。干预的门槛从“主治医生到主治医生”和“机构到机构”不等。社会人口因素据信不会影响临床决策。然而，妇产科医生确实更积极地管理体外受精妊娠。沟通不确定性、管理期望、评估理解以及在专业之间传递一致的信息，这些经常被描述为妇产科医生面临的咨询挑战。
机构差异和体外受精对极早产儿决策的影响值得进一步考虑。需要培训和支持妇产科医生沟通不确定性、管理期望以及评估价值观和理解的干预措施。
