Gaucher Nathalie, Nadeau Sophie, Barbier Alexandre, Payot Antoine
Division of Pediatric Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Clinical Ethics Unit, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
Arch Dis Child Fetal Neonatal Ed. 2018 Jan;103(1):F36-F42. doi: 10.1136/archdischild-2016-312448. Epub 2017 Jun 6.
To evaluate whether the antenatal consultation for preterm labour worries or reassures women, and to identify factors contributing to these feelings.
This is a prospective survey study from April 2012 to September 2013. This mixed-methodology tool was co-constructed with patients and first tested in a single-centre pilot study.
Three university-affiliated, tertiary care, high-risk obstetrics inpatient units in Quebec, Canada.
Women hospitalised with threatened preterm labour between 26 and 32 weeks' gestational age completed the survey within 72 hours of an antenatal consultation by neonatology. 341 women were invited to participate and 226 mothers completed the survey (72% response rate), at a median gestational age of 30 weeks.
Participant worry, reassurance and change in perception after the antenatal consultation were the main outcome measures. Multivariable logistic regression was used to identify factors associated with these outcomes.
23% of participants were worried by the consultation, and 87% were reassured by it. Lower gestational age and higher maternal education were associated with feeling worried (adjusted OR=0.83, 95% CI 0.70 to 0.99; and adjusted OR=2.15, 95% CI 1.04 to 4.44, respectively). Longer consultations were associated with reassurance (adjusted OR=8.21, 95% CI 2.67 to 25.26). Women were reassured by (1) feeling well informed about prematurity with optimistic outlooks, and (2) a trusting and reassuring expert neonatology team. High-quality interactions with neonatologists were associated with reassurance, while poorer communications were associated with feelings of worry.
To be reassuring, neonatologists should strive to establish a trusting relationship with mothers, in which realistic and clear, but optimistic, information is offered.
评估产前咨询对于早产相关问题是使女性感到担忧还是安心，并确定导致这些感受的因素。
这是一项从2012年4月至2013年9月的前瞻性调查研究。这种混合方法工具是与患者共同构建的，并在单中心试点研究中进行了首次测试。
加拿大魁北克的三个大学附属的三级护理高危产科住院单元。
孕26至32周因先兆早产住院的女性在新生儿科进行产前咨询后72小时内完成调查。邀请了341名女性参与，226名母亲完成了调查（回复率72%），中位孕周为30周。
产前咨询后参与者的担忧、安心程度以及认知变化是主要观察指标。采用多变量逻辑回归来确定与这些结果相关的因素。
23%的参与者因咨询而感到担忧，87%的参与者因咨询而感到安心。孕周较小和母亲教育程度较高与感到担忧相关（调整后的比值比分别为0.83，95%置信区间0.70至0.99；以及2.15，95%置信区间1.04至4.44）。咨询时间较长与感到安心相关（调整后的比值比为8.21，95%置信区间2.67至25.26）。女性因以下两点而感到安心：（1）对早产有充分了解且前景乐观，（2）有一个值得信赖且令人安心的新生儿科专家团队。与新生儿科医生的高质量互动与安心相关，而较差的沟通则与担忧情绪相关。
为了让患者安心，新生儿科医生应努力与母亲建立信任关系，提供现实、清晰但乐观的信息。
