Evaluating How Beliefs Among Pediatric Cardiology Providers May Affect Fetal Cardiac Counseling-A National Perspective.

BACKGROUND

Prenatal counseling following a fetal diagnosis of critical congenital heart disease (CCHD) is challenging and requires delivery of detailed and complete information to ensure appropriate decision making and pregnancy support.

METHODS

An anonymous 50-item survey was distributed to providers who performed fetal cardiac counseling. The primary purpose was to evaluate on a national scale physician beliefs and attitudes toward available choices after a fetal diagnosis of CCHD and their association with reported counseling practices. Participants were specifically asked to indicate how likely they were to recommend postnatal interventional and/or surgical treatment, postnatal palliative care, or termination of pregnancy. The primary outcome variables were provider responses to statements about pregnancies complicated by CCHD diagnosed in utero.

RESULTS

There were 138 respondents, with most somewhat or strongly agreeing that providing counseling on surgical and catheter-based interventions anticipated in the short- and long-term (99%, 136/138), counseling on a "comfort care" alternative with limited intervention (97%, 134/138), and options for pregnancy termination at different stages (91%, 126/138) should be included. Physicians that disagreed with the statement "some life is better than no life at all" were statistically more likely (p < 0.001) to report that prenatal counseling regarding "options for pregnancy termination services at different stages of pregnancy" was important. There was a statistically significant difference in the counseling provided to parents based on the physician's personal and professional views on palliative care and termination of pregnancy.

CONCLUSION

Physicians' self-reported beliefs impact the counseling content provided to families in the setting of a prenatal diagnosis of CCHD.