The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study.

Autor: Thorvilson MJ; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA. Thorvilson.Megan@mayo.edu., Carroll K; School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australia., Kaemingk BD; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA.; Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Pediatrics, Sanford Children's Hospital, Fargo, ND, USA.; Department of Pediatrics, University of North Dakota, Grand Forks, ND, USA., Schaepe KS; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Collura CA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905 (507)-255-0117, USA.; Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: Maternal health, neonatology and perinatology [Matern Health Neonatol Perinatol] 2023 Dec 01; Vol. 9 (1), pp. 15. Date of Electronic Publication: 2023 Dec 01.
DOI: 10.1186/s40748-023-00168-y
Abstrakt: Background: In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates.
Methods: This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists' discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters.
Results: In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus's presence, and (iii) fetal role in decision-making.
Conclusion: Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.
(© 2023. The Author(s).)
Databáze: MEDLINE
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