Improving Antenatal Counseling for High-Risk Pregnancies Through Shared-Decision Making

Approximately 0.5% of babies in the United States are born extremely preterm (<28 weeks gestation). These babies suffer mortality rates as high as 30-50%; survivors suffer morbidity rates up to 20-25%. Due to economic impact and uncertain outcomes, parents expecting the birth of an infant between 22 and 25 weeks' gestation are often asked to make a choice regarding whether or not to resuscitate their baby. Obstetric and Neonatal health care providers (HCP) routinely provide antenatal counseling to the parents of these babies in order to help them decide how to proceed. Historically, this counseling lacks consistency and there is much opportunity to optimize delivery. Some best practices have been suggested to support improved antenatal counseling. Shared-decision making (SDM) with incorporation of multidisciplinary support (MDS) is a best approach for making these important decisions. Also, the principles of Rogers Diffusion of Innovation theory, when applied to a process, increase the potential for adoption. These principles could facilitate improved antenatal counseling through offering practices which have an advantage over the current process, are aligned with existing values, and systems which are easy to understand and implement. MethodsA pre-project survey was administered to HCP (n=8) to assess their training and baseline knowledge of SDM. Standardized education regarding SDM with incorporation of MDS was completed. Participants were introduced to an SDM tool to be used as a guideline for antenatal counseling. Antenatal counseling was subsequently performed, using the SDM tool, and the patients (n=6) were surveyed regarding their perception of the education in relation to SDM. A chart review was performed to document frequency of MDS incorporation. A post-project survey was then administered to HCP for comparison to the pre-project survey. The Wilcoxon Matched-Pairs test was used to evaluate HCP pre/post-survey responses to the training and use of SDM tool. ResultsThe findings supported the hypothesis of increasing HCP (n=8) knowledge, perception, and attitudes toward SDM following implementation of this project. Moderately significant results were found related to HCP comfort conducting antenatal counseling (P=0.028), HCP access to adequate resources to perform antenatal counseling (p=0.035), and HCP offering of consistent and effective antenatal education (p=0.053). The patients (n=6) who received antenatal counseling during this project responded "completely agree" to 75% of the survey questions which was a strong indication that the encounter demonstrated effective use of SDM. MDS was incorporated into all of the encounters. ConclusionThe results of this project were positive for both HCP and study participants. The HCP indicated they would continue to use the SDM tool to retain improved outcomes observed during the project. There is potential for the standardized education and SDM tool to be duplicated and incorporated in other departments and facilities. This project can be implemented in any facility that offers antenatal counseling to parents expecting the delivery of an extremely preterm infant.