Department of Development and Regeneration cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.
Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium.
Prenat Diagn. 2021 Jan;41(2):179-189. doi: 10.1002/pd.5849. Epub 2020 Nov 5.
Running randomized clinical trials (RCT) in fetal therapy is challenging. This is no different for fetoscopic endoluminal tracheal occlusion (FETO) for severe left-sided Congenital Diaphragmatic Hernia (CDH). We assessed the knowledge, attitude and practice (KAP) of maternal-fetal medicine specialists toward the antenatal management of CDH, and the randomized controlled clinical (RCT) "Tracheal Occlusion To Accelerate Lung growth-trial."
A cross-sectional KAP-survey was conducted among 311 registrants of the 18th World Congress in Fetal Medicine.
The overall knowledge of CDH and FETO was high. Remarkably only 45% considers prenatal prediction of neonatal outcome reliable. Despite, in their clinical practice they perform severity assessment (80%) and refer families for FETO either within the context of an RCT (43%) or on patient request (32%). Seventy percent perceives not offering FETO on patient demand seems as if no treatment is provided to a fetus with predicted poor outcome. Only 20% of respondents considers denying access to FETO on patient demand not as a psychological burden.
Often the views of individual respondents contradicted with their clinical practice. It seems that, for severe CDH, clinicians face personal and practical dilemmas that undermine equipoise. To us, this indicates the tension between the clinical and scientific obligations physicians experience.
在胎儿治疗中进行随机临床试验（RCT）具有挑战性。对于严重左侧先天性膈疝（CDH）的胎儿内窥镜腔内气管阻塞（FETO）也是如此。我们评估了母胎医学专家对 CDH 产前管理的知识，态度和实践（KAP），以及随机对照临床试验（RCT）“气管阻塞加速肺生长试验”。
在第 18 届胎儿医学世界大会的 311 名注册者中进行了横断面 KAP 调查。
对 CDH 和 FETO 的总体认识水平较高。值得注意的是，只有 45％的人认为产前预测新生儿结局是可靠的。尽管如此，在他们的临床实践中，他们进行严重程度评估（80％），并根据 RCT（43％）或患者要求（32％）将家庭转介进行 FETO。70％的人认为，如果根据患者的要求不提供 FETO，就好像没有为预测预后不良的胎儿提供治疗。只有 20％的受访者认为拒绝根据患者的要求拒绝 FETO 不会带来心理负担。
通常情况下，个别受访者的观点与他们的临床实践相矛盾。对于严重的 CDH，临床医生似乎面临着个人和实际的困境，从而破坏了平衡。对我们来说，这表明了医生所经历的临床和科学义务之间的紧张关系。
