End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Ghent, Belgium.
Department of Obstetrics, Women's Clinic, University Hospital Ghent, Ghent, Belgium.
Acta Obstet Gynecol Scand. 2021 Jan;100(1):74-83. doi: 10.1111/aogs.13967. Epub 2020 Aug 16.
Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes at a gestational age when the fetus is already viable (late TOP). We aimed to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice.
A mail survey was conducted among all physicians and paramedical professionals involved in late TOP decision-making in all eight centers with a Neonatal Intensive Care Unit in Flanders, Belgium (N = 117). The questionnaire contained general and case-based attitude items.
Response rate was 79%. Respondents were either physicians (51.1%) or paramedical professionals (49.9%). The composition of professionals involved in late TOP decision-making was heterogeneous between the eight centers. Late TOP was highly accepted in both lethal fetal conditions (100%) and serious (but not lethal) fetal conditions (95.6%). Where the fetus is healthy, 19.8% of respondents agreed with late TOP for maternal psychological problems and fewer respondents (13.2%) agreed with late TOP in the case of maternal socio-economic problems (P = .002). Physicians more often preferred feticide over neonatal palliative care in the case of non-lethal fetal conditions compared with paramedical professionals (68.1% vs 53.2%, P = .013). Almost nine out of ten respondents (89.1%) agreed that in the event of a serious (non-lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life was acceptable. Behavioral intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP.
Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are demanding legislative change regarding active life-ending in the fetal and neonatal periods. Further research should explore the correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.
在产前诊断出先天性畸形后，终止妊娠（TOP）可能是一种选择，有时是在胎儿已经存活（晚期 TOP）的孕龄。我们旨在研究所有参与晚期 TOP 实践的三级保健专业人员对晚期 TOP 的态度。
在比利时佛兰德斯的所有 8 个设有新生儿重症监护病房的中心，向所有参与晚期 TOP 决策的医生和辅助医疗专业人员进行了邮件调查（N=117）。问卷包含一般和基于案例的态度项目。
回复率为 79%。受访者要么是医生（51.1%），要么是辅助医疗专业人员（49.9%）。8 个中心参与晚期 TOP 决策的专业人员组成存在异质性。在致命胎儿情况（100%）和严重（但非致命）胎儿情况（95.6%）中，晚期 TOP 得到高度认可。如果胎儿健康，19.8%的受访者同意因母亲的心理问题进行晚期 TOP，而较少的受访者（13.2%）同意因母亲的社会经济问题进行晚期 TOP（P=0.002）。与辅助医疗专业人员相比，医生在非致命胎儿情况下更倾向于选择胎儿杀除而非新生儿姑息治疗（68.1%比 53.2%，P=0.013）。近十分之九的受访者（89.1%）同意，如果出现严重（非致命）新生儿情况，给予明确意图结束新生儿生命的药物是可以接受的。行为意向表明，即使在情况不明和预后不可预测的情况下，85.6%的专业人员仍会考虑晚期 TOP。
在比利时佛兰德斯进行晚期 TOP 的保健专业人员对晚期 TOP 有很高的容忍度，不论社会人口因素如何，并要求对胎儿和新生儿期的主动结束生命进行立法改革。进一步的研究应该探讨对晚期 TOP 的态度与日常临床实践中的实际医疗决策之间的相关性。
