Dewitt Barry
Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Canada.
Semin Perinatol. 2025 Apr;49(3):152051. doi: 10.1016/j.semperi.2025.152051.
Decision science offers an opportunity to understand perspectives on perinatal decision making, from understanding risk and uncertainty, to decision-maker preferences. Here, I describe a specific instance of making perinatal medical decisions from the perspective of a decision scientist and a parent navigating clinical uncertainty. I explain how clinical encounters did and did not provide the required information needed to make choices informed by decision science methods and results. My purpose is to provide modest inspiration to those working at the intersection of decision science and perinatal/neonatal medicine about problems their disciplines could solve to improve the experience of decision-makers.Years before I would have children of my own, I read Detlof von Winterfeldt's account of his wife deciding whether to undergo a procedure to try and move her nearly-term fetus out of the breech position (1). He describes his analysis of the problem, informed by his wife's values and preferences. That analysis revealed that the best decision was unambiguously not to do the procedure, despite the opposing view of his wife's physician, who had not thought through what the evidence meant for them, nor considered von Winterfeldt's wife's preferences. The account is an illustrative description of the decision-analytic method, showing how science, beliefs, and values can be integrated into a framework to guide medical (and other) decision making.
决策科学提供了一个机会,来理解围产期决策的各种观点,从理解风险和不确定性,到了解决策者的偏好。在此,我将从决策科学家和一位在临床不确定性中摸索前行的家长的角度,描述一个围产期医疗决策的具体实例。我将解释临床接触是如何提供以及未能提供依据决策科学方法和结果做出选择所需的必要信息的。我的目的是为那些在决策科学与围产期/新生儿医学交叉领域工作的人提供些许启发,让他们了解各自学科能够解决哪些问题,从而改善决策者的体验。在我自己有孩子的几年前,我读了德特洛夫·冯·温特费尔特讲述他妻子决定是否接受一项试图将接近足月的胎儿从臀位转出来的手术的经历(1)。他描述了基于妻子的价值观和偏好对这个问题的分析。该分析表明,尽管他妻子的医生持相反观点,且这位医生既没有思考证据对他们意味着什么,也没有考虑冯·温特费尔特妻子的偏好,但最佳决策显然是不做这个手术。这个经历是对决策分析方法的一个示例性描述,展示了科学、信念和价值观如何能够整合到一个框架中,以指导医疗(以及其他)决策。