Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals

R Geurtzen, Arno Van Heijst, Rosella Hermens, Hubertina Scheepers, Mallory Woiski, Jos Draaisma, Marije Hogeveen, R Geurtzen, Arno Van Heijst, Rosella Hermens, Hubertina Scheepers, Mallory Woiski, Jos Draaisma, Marije Hogeveen

Abstract

Background: Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care.

Methods: Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice.

Results: One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals.

Conclusions: Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework.

Trial registration: Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

Keywords: (extreme) prematurity; (limits of) viability; Counselling; Decision-making.

Conflict of interest statement

Ethics approval and consent to participate

This study was exempt from IRB approval because of the survey-methodology examining only professionals, this was confirmed by the IRB (CMO region Arnhem – Nijmegen, file number 2015-1998).

Consent for Publication

Not applicable.

Competing interests

All authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Percentages of obstetricians that ask the neonatologist for prenatal counselling in threatened preterm delivery
Fig. 2
Fig. 2
Morbidity and mortality rates currently provided by neonatologist during prenatal counselling (24 weeks GA)
Fig. 3
Fig. 3
Preferred decision-making-model at 24 weeks GA on inititating intensive treatment at birth or not. Answer options: •The decision to initiate intensive treatment at birth should only be made by a health care professional (paternalistic model). •The decision to initiate intensive treatment at birth should be made by the parents, after prenatal counselling (informed model). •The decision to initiate intensive treatment at birth should be made by the health care professional and parents together (shared-decision model)

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