Doucette Stefani, Lemyre Brigitte, Daboval Thierry, Dunn Sandra, Akiki Salwa, Barrowman Nick, Moore Gregory P
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Am J Perinatol. 2017 Aug;34(10):982-989. doi: 10.1055/s-0037-1601308. Epub 2017 Apr 4.
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. 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. 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% ( < 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, < 0.001-0.004) between knowledge responses and attitudes. 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.
为了确定医疗保健提供者（HCP）对极早产儿（EPI）存活率的了解情况以及在一次教育讲座前后对复苏的态度，并研究对复苏的知识与态度之间的关系。参与者在参加一场详细介绍基于证据的存活率估计及相关伦理问题的讲座前后完成了一项调查。受访者包括新生儿科医生、产科医生、儿科医生、母胎医学专家、儿科、产科、新生儿围产医学专业的实习生以及新生儿和产科护士。
总共有166名参与者参加了教育讲座，130名参与者完成了讲座前和讲座后的调查（回复率78%）。讲座前，对于所有孕周，≤50%的受访者正确识别了存活率/完整存活率。讲座后，关于存活率/完整存活率的正确回答率在49%至86%之间（<0.001），并且态度转变为在所有孕周更倾向于进行复苏，无论父母的意愿如何。知识回答与态度之间存在弱到中等程度的关系（斯皮尔曼系数为0.24 - 0.40，<0.001 - 0.004）。
参加教育讲座确实提高了医疗保健提供者对极早产儿存活率和长期预后的了解，但医疗保健提供者仍然低估了存活率，并且并不总是愿意按照父母的意愿进行复苏。这些发现可能代表了一些专家在考虑为极早产儿选择复苏方案时建议与父母采用共同决策的障碍。
