170 - Physician Attitudes and Counseling Practices Regarding Intervention for Infants with Trisomy 18

Poster Number: 170
Publication Number: 170.233

Caitlin Jacowski, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Uchenna E. Anani, Vanderbilt University Medical Center, Nashville, TN, United States; Wu Gong, Vanderbilt University Medical Center, Nashville, TN, United States

Background: Trisomy 18 (T18) is a genetic aneuploidy with a heterogenous phenotype often associated with congenital heart disease, surgical co-morbidities, and significant developmental disability. Traditionally, T18 has been regarded as “lethal” with little to no medical intervention offered. However, with recent data and improved outcomes, the current climate towards T18 is shifting toward more interventions through individualized treatment and care.  Nevertheless, it is presumed some providers may still limit interventions offered for patients with T18. Therefore, a better evaluation of physician attitudes and counseling practices is warranted.

Objective: To evaluate if 1) there are discrepancies between physician attitudes for T18 based on specialty; 2) there is a correlation between physician attitudes and counseling style/practice toward T18; and 3) there are additional factors that may explain differences in attitude and counseling style/practice.

Design/Methods: We conducted a mixed methods study using a survey administered nationally to obstetricians (OBs), maternal fetal medicine physicians (MFMs), neonatologists (Neos), and pediatric cardiologists at academic and non-academic centers (N ~ 3600). Our survey consisted of questions on a Likert scale that addressed attitudes and counseling style surrounding types of interventions for T18, including monitored labor, resuscitation, nutrition, surgical and cardiac interventions. Qualitative data was collected through free-text box comments.

Results: We found that Neos were more likely to support aggressive resuscitation at delivery including intubation and chest compressions compared to OB/MFMs (p=0.015). Secondary analysis to assess congruency of attitudes to counseling style is in progress. Qualitative analysis showed limited responses alluding to the “lethality” of T18 (in contrast with previous studies), and a large proportion highlighting parental preference with adequate counseling. Attitudes were more unfavorable as invasiveness of procedures or severity of phenotype increased. Non-supportive counseling appeared to align with unfavorable attitudes with the theme of compliance toward aggressive intervention only upon family request.Conclusion(s): Although there is a continued shift toward interventions and individualized care for T18 infants, there remains a difference in attitudes among specialty type. Future studies are needed to evaluate the importance of multidisciplinary discussion and equitable counseling through equally distributed information and options of care for all families of patients with T18.
Attitudes Regarding Resuscitation of Infants with Trisomy 18Comparison of obstetrician and neonatologists attitudes regarding the most reasonable extent of Neonatal Resuscitation at delivery