James Cook University, College of Medicine and Dentistry, Angus Smith Drive, Townsville, Australia.
Neonatal unit, Townsville University Hospital, Townsville, Australia.
BMC Pregnancy Childbirth. 2021 Jan 13;21(1):55. doi: 10.1186/s12884-021-03539-5.
A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies.
METHODS/DESIGN: Applying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive care for extremely premature babies. These babies are at increased risk of death and neurodisability when compared to babies of older gestations. Participants included HCP of varying disciplines at a large tertiary centre, a regional centre and a remote centre. Staff with a wide range of experience were interviewed.
Six categories of i) who decides, ii) culture and context of families, iii) the life ahead, iv) to treat a bit or not at all, v) following guidelines and vi) information sharing, emerged. Role specific implicit bias was found as a theoretical construct, which depended on the period for which care was provided relative to the delivery of the baby. This implicit bias is an underlying cause for the negativity seen towards extreme prematurity and is presented in this paper. HCP caring for women prior to delivery have a bias towards healthy term babies that involves overestimation of the risks of extreme prematurity, while neonatal staff were biased towards suffering in the neonatal period and paediatricians recognise positivity of outcomes regardless of neurological status of the child. The implicit bias found may explain negativity towards intensive care of periviable neonates.
Understanding the presence and origins of role specific implicit bias may enable HCP to work together to improve care for parents preparing for the delivery of extremely premature babies.
本研究旨在探讨相关医护人员（HCP）对提供极早产儿和近极早产儿重症监护的态度。
方法/设计：采用建构主义扎根理论方法，对 HCP 就为极早产儿提供复苏和重症监护的态度进行了访谈。与胎龄较大的婴儿相比，这些婴儿死亡和神经发育障碍的风险更高。参与者包括大型三级中心、区域中心和偏远中心的不同专业的 HCP。采访了具有广泛经验的工作人员。
出现了六个类别：i）谁来决定，ii）家庭的文化和背景，iii）未来的生活，iv）治疗一点还是不治疗，v）遵循指南，vi）信息共享。发现了特定于角色的隐性偏见，这是一个理论结构，取决于提供护理的时间相对于分娩的时间。这种隐性偏见是对极早产儿产生负面看法的根本原因，本文对此进行了介绍。在分娩前照顾妇女的 HCP 对健康足月婴儿存在偏见，这种偏见涉及对极早产儿风险的高估，而新生儿工作人员对新生儿期的痛苦存在偏见，而儿科医生则认识到无论孩子的神经状态如何，结果都是积极的。发现的隐性偏见可能解释了对近极早产儿重症监护的负面态度。
了解特定角色隐性偏见的存在和来源，可以使 HCP 共同努力，改善为准备分娩极早产儿的父母提供的护理。
