Schouten Esther S, Beyer Maria F, Flemmer Andreas W, de Vos Mirjam A, Kuehlmeyer Katja
Division of Neonatology, LMU University Children's Hospital, Dr. v. Hauner, Munich, Germany.
Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Centre, Amsterdam, Netherlands.
Front Pediatr. 2022 May 23;10:897014. doi: 10.3389/fped.2022.897014. eCollection 2022.
Advances in perinatal medicine have contributed to significantly improved survival of newborns. While some infants die despite extensive medical treatment, a larger proportion dies following medical decision-making (MDM). International guidelines about end-of-life (EOL) MDM for neonates unify in their recommendation for shared decision-making (SDM) between doctors and parents. Yet, we do not know to what extent SDM is realized in neonatal practice.
We aim at examining to which extent SDM is implemented in the NICU setting.
By means of Qualitative Content Analysis, audio-recorded conversations between neonatologists and parents were analyzed. We used a framework by de Vos that was used to analyze similar conversations on the PICU.
In total we analyzed 17 conversations with 23 parents of 12 NICU patients. SDM was adopted only to a small extent in neonatal EOL-MDM conversations. The extent of sharing decreased considerably over the stages of SDM. The neonatologists suggested finding a decision together with parents, while at the same time seeking parents' agreement for the intended decision to forgo life-sustaining treatment.
Since SDM was only realized to a small extent in the NICU under study, we propose evaluating how parents in this unit experience the EOL-MDM process and whether they feel their involvement in the process acceptable and beneficial. If parents evaluate their involvement in the current approach beneficial, the need for implementation of SDM to the full extent, as suggested in the guidelines, may need to be critically re-assessed.
围产期医学的进步显著提高了新生儿的存活率。尽管一些婴儿在接受广泛的医疗治疗后仍死亡，但更大比例的婴儿是在医疗决策（MDM）后死亡。关于新生儿临终（EOL）MDM的国际指南一致建议医生和父母进行共同决策（SDM）。然而，我们并不清楚SDM在新生儿实践中的实现程度。
我们旨在研究SDM在新生儿重症监护病房（NICU）环境中的实施程度。
通过定性内容分析，对新生儿科医生与父母之间的音频对话进行了分析。我们使用了德沃斯的一个框架，该框架用于分析儿科重症监护病房（PICU）的类似对话。
我们总共分析了12名NICU患者的23位父母的17次对话。在新生儿EOL-MDM对话中，SDM仅在很小程度上被采用。在SDM的各个阶段，共享程度大幅下降。新生儿科医生建议与父母共同做出决定，同时寻求父母对放弃维持生命治疗这一预期决定的同意。
由于在所研究的NICU中，SDM仅在很小程度上得以实现，我们建议评估该科室的父母如何体验EOL-MDM过程，以及他们是否觉得自己参与该过程是可接受且有益的。如果父母认为他们参与当前方法是有益的，那么可能需要对指南中建议的全面实施SDM的必要性进行严格重新评估。
