Link: http://www.ncbi.nlm.nih.gov/pubmed/25870957

J Perinat Med. 2015 Apr 14. pii: /j/jpme.ahead-of-print/jpm-2015-0039/jpm-2015-0039.xml. doi: 10.1515/jpm-2015-0039. [Epub ahead of print]

Communication about maternal-fetal surgery for myelomeningocele and congenital diaphragmatic hernia: preliminary findings with implications for informed consent and shared decision-making.

Blumenthal-Barby JS, Krieger H, Wei A, Kim D, Olutoye OO, Cass DL.

Abstract
OBJECTIVE:
To examine the style and content of consultations for maternal-fetal surgery and draw conclusions about best practices for informed consent and shared decision-making.

STUDY DESIGN:
Qualitative study of 15 h-long consultations with women diagnosed with fetal myelomeningocele (MMC, n=11) or congenital diaphragmatic hernia (CDH, n=4) who were potential candidates for maternal-fetal surgery at a large children's hospital in the Southwestern US.

RESULTS:
Major findings were that physicians tended to discuss the risks of fetal prognosis qualitatively more often than quantitatively (70% compared to 30%) and when mortality was a risk the "positive" (percentage survival) frame was always given rather than the morality frame. On average, families only talked 15% of the time and 45% of all their questions were about diagnostic or surgical procedure clarification.

CONCLUSION:
Efforts should be made to minimize qualitative presentation of risk, which can be vague and confusing to patients. Both survival and mortality frames should be used to avoid biased decision-making. Communication and decision support tools that facilitate more shared decision-making between families and physicians are needed.

PMID: 25870957 [PubMed - as supplied by publisher]