Indiana University School of Medicine, Indianapolis (Ms Jager); Children's Hospital of Wisconsin, Milwaukee (Dr Kavanaugh); College of Nursing, University of Illinois at Chicago (Dr Kavanaugh); and Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (Ms Hoffman and Drs Laitano, Jeffries, and Tucker Edmonds).
J Perinat Neonatal Nurs. 2020 Apr/Jun;34(2):178-185. doi: 10.1097/JPN.0000000000000483.
During periviable deliveries, parents are confronted with overwhelming and challenging decisions. This study aimed to qualitatively explore the language that pregnant women and important others utilize when discussing palliation, or "comfort care," as a treatment option in the context of periviability. We prospectively recruited women admitted for a threatened periviable delivery (22-25 weeks) at 2 hospitals between September 2016 and January 2018. Using a semistructured interview guide, we investigated participants' perceptions of neonatal treatment options, asking items such as "How was the choice of resuscitation presented to you?" and "What were the options presented?" Conventional content analysis was used and matrices were created to facilitate using a within- and across-case approach to identify and describe patterns. Thirty women and 16 important others were recruited in total. Participants' descriptions of treatment options included resuscitating at birth or not resuscitating. Participants further described the option to not resuscitate as "comfort care," "implicit" comfort care, "doing nothing," and "withdrawal of care." This study revealed that many parents facing periviable delivery may lack an understanding of comfort care as a neonatal treatment option, highlighting the need to improve counseling efforts in order to maximize parents' informed decision-making.
在极早产儿分娩期间，父母会面临压倒性和具有挑战性的决策。本研究旨在定性探讨孕妇和重要他人在极早产儿分娩背景下讨论姑息治疗（即“舒适护理”）时使用的语言。我们前瞻性地招募了 2016 年 9 月至 2018 年 1 月期间在 2 家医院因有早产风险而入院的女性。使用半结构化访谈指南，我们调查了参与者对新生儿治疗选择的看法，询问了“复苏的选择是如何向您提出的？”和“提出了哪些选择？”常规内容分析，并创建了矩阵，以方便使用案例内和案例间方法来识别和描述模式。总共招募了 30 名女性和 16 名重要他人。参与者对治疗选择的描述包括出生时复苏或不复苏。参与者进一步将不复苏的选择描述为“舒适护理”、“隐性”舒适护理、“不作为”和“停止护理”。这项研究表明，许多面临极早产儿分娩的父母可能对舒适护理作为新生儿治疗选择缺乏了解，这凸显了需要加强咨询工作，以最大限度地提高父母的知情决策。
