Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Bioethics, Harvard Medical School, Boston, MA, USA.
Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Bioethics, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Semin Perinatol. 2022 Apr;46(3):151529. doi: 10.1016/j.semperi.2021.151529. Epub 2021 Nov 9.
Decision-making at extreme prematurity remains ethically and practically challenging and can result in parental and clinician distress. It is vital that clinicians learn the necessary skills integral to counseling and decision-making with families in these situations. A pedagogical approach to teaching counseling should incorporate adult learning theory, emphasize multidisciplinary team in-situ simulation that links to counseling clinicians' daily practice, and includes critical reflection, debriefing, and program assessment. Multiple educational strategies that train clinicians in advanced communication and decision-making offer promising results to optimize antenatal counseling and shared decision-making for families facing possible delivery at extreme prematurity. Continued process evaluation and innovation in these educational domains are needed while also assessing the effect on patient-centered outcomes.
在极早产的情况下做出决策在伦理和实践上仍然具有挑战性，并可能导致父母和临床医生的痛苦。至关重要的是，临床医生要学习与这些情况下的家庭进行咨询和决策相关的必要技能。教学咨询的教学方法应包含成人学习理论，强调与咨询临床医生日常实践相关的多学科团队现场模拟，并包括批判性反思、讨论和方案评估。培训临床医生进行高级沟通和决策的多种教育策略为优化面临极早产可能分娩的家庭的产前咨询和共同决策提供了有希望的结果。在评估对以患者为中心的结果的影响的同时，还需要对这些教育领域的持续过程评估和创新。
