Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Pediatrics. 2012 May;129(5):891-902. doi: 10.1542/peds.2011-0574. Epub 2012 Apr 9.
To examine whether parents' delivery room management decisions for extremely preterm infants are influenced by (1) the degree of detail with which options (comfort care [CC] or intensive care [IC]) are presented or (2) their order of presentation.
A total of 309 volunteers, 18 to 55 years old, were each randomized to 1 of 4 groups: (1) detailed descriptions, CC presented first; (2) detailed descriptions, IC presented first; (3) brief descriptions, CC presented first; or (4) brief descriptions, IC presented first. Each received the description of a hypothetical delivery of a 23-week gestation infant and chose either IC or CC. Open-ended and structured questions elicited reasoning. Data were analyzed by χ(2) and logistic regression analysis.
Neither degree of detail, comparing groups 1+2 with 3+4 (37% vs 41%, odds ratio = 0.85, 95% confidence interval = 0.54-1.34, P = .48), nor order, comparing groups 1+3 with 2+4 (40% vs 37%, odds ratio = 0.88, 95% confidence interval = 0.56-1.39; P = .59), influenced the likelihood of choosing IC. Participants choosing IC were more likely to invoke sanctity of life and religiosity as personal values. Additional reasons for choosing IC were experiences with infants born at later gestational ages, giving the infant a chance, not watching their infant die, and equating CC with euthanasia. Some choosing CC wanted to avoid infant suffering.
The degree of detail and order of presentation had no effect on treatment decisions, suggesting that individuals bring well-articulated preexisting preferences to such decisions. Understanding beliefs and attitudes motivating these preferences can assist physicians in helping parents make informed decisions consistent with their values.
探讨父母对极早产儿的产房管理决策是否受到以下因素的影响：（1）提供选项（舒适护理[CC]或强化护理[IC]）的详细程度；或（2）选项呈现的顺序。
共招募了 309 名志愿者，年龄在 18 至 55 岁之间，他们被随机分为 4 组中的 1 组：（1）详细描述，CC 首先呈现；（2）详细描述，IC 首先呈现；（3）简要描述，CC 首先呈现；或（4）简要描述，IC 首先呈现。每组志愿者都收到一份假设的 23 周妊娠婴儿分娩的描述，并选择 IC 或 CC。开放式和结构化问题引出他们的决策理由。通过 χ(2)和逻辑回归分析对数据进行分析。
呈现的详细程度（比较组 1+2 与 3+4，37%比 41%，比值比=0.85，95%置信区间=0.54-1.34，P=0.48），以及呈现顺序（比较组 1+3 与 2+4，40%比 37%，比值比=0.88，95%置信区间=0.56-1.39，P=0.59）均未影响选择 IC 的可能性。选择 IC 的参与者更可能将生命的神圣性和宗教信仰作为个人价值观。选择 IC 的其他原因包括有晚期妊娠婴儿的经历、给婴儿一个机会、不看着自己的婴儿死亡、将 CC 等同于安乐死。一些选择 CC 的人希望避免婴儿受苦。
呈现的详细程度和顺序对治疗决策没有影响，这表明个体在做出此类决策时会提出精心制定的预先存在的偏好。了解这些偏好背后的信念和态度，可以帮助医生帮助父母做出符合其价值观的知情决策。
