176 - Evaluating information conveyed by neonatologists in mock consultation for a mother facing extremely early delivery

Poster Number: 176
Publication Number: 176.234

Kaitlyn T. Mullin, Brooke Army Medical Center, San Antonio, TX, United States; Elizabeth Okonek, Brooke Army Medical Center, Fort Sam houston, TX, United States; Jeanne Krick, Brooke Army Medical Center, San Antonio, TX, United States; Christopher Mattson, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Carrie Litke, Brooke Army Medical Center, San Antonio, VA, United States; Uchenna E. Anani, Vanderbilt University Medical Center, Nashville, TN, United States; Peter D. Murray, University of Virginia School of Medicine, Charlottesville, VA, United States; Dalia M. Feltman, NorthShore University HealthSystem Evanston Hospital, Burr Ridge, IL, United States

Background: When an infant is born extremely premature, parents, in consultation with neonatologists and obstetric specialists, must decide whether to provide resuscitation for their child. There is little known about how providers engage in these consultations and what information they provide parents. A recent survey showed reported information topics discussed with parents varied by specialty and experience level, but it is unclear what is discussed in actual practice.1 A systematic approach to evaluate these consultations is needed to understand how neonatologists’ style and content affect parental decisions and to optimize education surrounding antenatal consultation practices.

Objective: To assess information discussed by neonatologists during antenatal consultation for extremely preterm delivery.

Design/Methods: For this prospective observational study, 14 neonatologists from 4 U.S. centers were video-recorded performing an antenatal consultation for a mock patient facing extremely preterm delivery at 22 weeks gestation. Each consultation was independently reviewed by 5 researchers utilizing a novel consultation checklist developed following an extensive literature review. Intraclass correlation coefficient (ICC) and Cronbach’s alpha were calculated to assess inter-rater agreement and internal consistency, respectively. Information topics discussed were also compared to reported topics discussed in a recent published survey of U.S. clinicians.

Results: Intraclass correlation coefficient demonstrated substantial inter-rater agreement with the novel checklist (0.9). The duration of mock consultation and the number of items discussed are found in Figure 1. Consultant characteristics are found in Table 1. The two most frequently discussed information items were intubation/mechanical ventilation (100%) and survival chances (92%). Several items were not mentioned by any neonatologists. See Table 2 for full results, including comparisons to reported topics from a previously published survey.Conclusion(s): Our novel checklist has excellent inter-rater reliability; validity as to whether these topics correlate to parent satisfaction requires study. What neonatologists actually discussed during mock antenatal consultations for mothers facing extremely preterm delivery stands somewhat in contrast to a survey of what providers reported discussing. Future studies will be aimed at assessing the parental reaction to these same video-recorded mock consultations and comparing their responses to the amount and variety of informational content discussed.
Figure 1. Characteristics of 14 Neonatologist's Mock Consultations
Table 1. Characteristics of Neonatologists Performing Mock Consultations