Shared Decision Making For Infants Born At The Threshold Of Viability: A Prognosis-based Guideline
Title
Shared Decision Making For Infants Born At The Threshold Of Viability: A Prognosis-based Guideline
Creator
Lemyre B; Daboval T; Dunn S; Kekewich M; Jones G; Wang D; Mason-Ward M; Moore GP
Publisher
Journal Of Perinatology : Official Journal Of The California Perinatal Association
Date
2016
Description
OBJECTIVE:
Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline.
STUDY DESIGN:
We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appraisal of published guidelines; (2) identification of key medical factors for decision making; (3) systematic reviews; (4) creation of a multi-disciplinary working group and (5) external consultation and appraisal.
RESULT:
No published guideline met high-quality appraisal criteria. Survival, neurodevelopmental disability, quality of life of child and parents, and maternal mortality and risk of long-term morbidity were identified as key for quality decision-making. Eighteen stakeholders (including parents) advocated for the incorporation of parents' values and preferences in the process.
CONCLUSION:
A novel framework, based on prognosis, was generated to guide when early intensive and palliative care may both be offered to expectant parents. Pre-implementation assessment is underway to identify barriers and facilitators to putting in practice.
Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline.
STUDY DESIGN:
We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appraisal of published guidelines; (2) identification of key medical factors for decision making; (3) systematic reviews; (4) creation of a multi-disciplinary working group and (5) external consultation and appraisal.
RESULT:
No published guideline met high-quality appraisal criteria. Survival, neurodevelopmental disability, quality of life of child and parents, and maternal mortality and risk of long-term morbidity were identified as key for quality decision-making. Eighteen stakeholders (including parents) advocated for the incorporation of parents' values and preferences in the process.
CONCLUSION:
A novel framework, based on prognosis, was generated to guide when early intensive and palliative care may both be offered to expectant parents. Pre-implementation assessment is underway to identify barriers and facilitators to putting in practice.
Rights
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Citation List Month
May 2016 List
Citation
Lemyre B; Daboval T; Dunn S; Kekewich M; Jones G; Wang D; Mason-Ward M; Moore GP, “Shared Decision Making For Infants Born At The Threshold Of Viability: A Prognosis-based Guideline,” Pediatric Palliative Care Library, accessed April 24, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10614.