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| Author/date/ country | Muthusamy et al. (2012)
Texas, USA | Guillen et al. (2012)
Pennsylvania, USA | Kakkilaya et al. (2011)
Texas, USA |
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| Aims | To assess the effect of providing written information during counselling | To assess outcome of a decision-aid to counsel parents facing premature delivery | To assess outcome of a visual aid to counsel parents facing premature delivery |
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| Study design | Randomized | Nonrandomized | Randomized |
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| Setting | Two hospitals with delivery units and level 3 neonatal intensive care unit | Three urban tertiary care hospitals | A university obstetric clinic serving primarily low-income patients |
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| Patients/participants | Women at risk of preterm delivery (23–34 weeks) randomized as follows:
N = 30 verbal and written versus N = 30 verbal | N = 24 couples of parents (13 with past experience with preterm baby and 11 naive) | N = 89 women after 28 weeks of a regular pregnancy (44 visual aid; 45 control) |
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| Professional | Not specified | 31 clinicians | Neonatologist |
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| Tools applied in counselling | Handout of 5 to 7 pages reporting gestational-age specific information | Visual aids including 6 cards (13 cm × 23 cm) with scripts | Visual aids including graphics, pictures, and short messages |
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| Timing and sessions of counselling | At imminent preterm labour | A simulated counselling session at imminent preterm labour | A simulated counselling session at imminent preterm labour |
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| Style of communication | No description | No description | The counselling was defined as “nondirective” |
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| Contents of counselling | Parental rights to refuse NICU treatment; delivery room care and resuscitation; common treatments and complications; incidence rates of select problems | Size and appearance of preterm baby
Survival rates
Short term risks | Survival, disability
Duration NICU stay
Short- and long-term problems
Comfort care versus intensive care |
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| Study outcome | (i) Recall of information measured by an ad hoc questionnaire
(ii) Anxiety measured by State-Trait
(iii) Anxiety inventory (Spielberger 1970) | (i) Knowledge measured by an ad hoc questionnaire administered before and after counselling | (i) Recall of information measured by open-ended oral questions
(ii) Parental choices assessed before and after counselling |
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| Main study results | Written information improved knowledge of long-term problems and numerical outcome data, and it also decreased anxiety | Participants found the cards useful and easy to understand. The level of knowledge improved after counselling both for “experienced” parents and “naïve” parents | Women counselled with visual aid recalled more short-term problems, more long-term disability, and longer NICU stay than controls. Attitudes toward resuscitation did not change after counselling in either group |
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| Author/date/ country | Kaempf et al. (2009)
Oregon, USA | Zupancic et al. (2002)
Ontario, USA | Haward et al. (2012)
USA |
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| Aims | To assess the outcome of consensus medical staff guidelines for counselling women at risk of premature birth | To assess outcome of counselling in a routine setting of care | To examine whether choices between comfort care (CC) and intensive care (IC) are affected by the details and the order of presentation |
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| Study design | Nonrandomized | Nonrandomized | Randomized |
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| Setting | Level III for high-risk obstetric and neonatal intensive care unit | Tertiary level referral unit | Online |
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| Patients/participants | N = 50 women admitted for potential premature delivery (22–26 weeks) | N = 40 women and their partners with diagnosis of preterm labour (23–30 weeks) | N = 309 participants in parenting age (18–55 years) |
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| Professional | Not specified | Obstetrician or house staff, and neonatologist separately | The consultation was based on a simulation, particularly on written info (i.e. 2 written pages) |
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| Tools applied in counselling | A consensus about periviability guidelines | Any | The consultation was based on a simulation, particularly on written info (i.e., 2 written pages) |
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| Timing and sessions of counselling | Imminent premature delivery | At admission for preterm delivery | The consultation was based on a simulation, particularly on written info (i.e., 2 written pages) |
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| Style of communication | Family were encouraged to engaged in decision process. The discussion encompassed preferences and values | The format of consultation was left to the discretion of the clinician | The consultation was based on a simulation, particularly on written info (i.e., 2 written pages) |
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| Contents of counselling | (i) Outcome data of premature delivery
(ii) Medical care options | (i) Pregnancy complications
(ii) Maternal and infant prognosis
(iii) Management options | (i) Outcome data of premature delivery
(ii) Treatment options (CC or IC) |
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| Study outcome | (i) Satisfaction measured by an ad hoc questionnaire filled 3 days, 6 months, and 18 months after counselling | (i) The level of concordance between parental and clinician about discussed information measured by an ad hoc questionnaire | (i) Choice among CC or IC |
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| Main study results | The women felt comfortable asking questions. About 60% of the mothers mentioned the written guidelines as the most useful information given to them | The agreement score correlated negatively with the level of anxiety. The agreement for obstetric variables was good, while concordance on potential neonatal problems was generally poor | (ii) Order had no effect on final choice
(ii) Participants were significantly less
likely to choose CC if they were highly religious or valued preservation of life
over quality of life |
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| Author/date/ country | Tucker Edmonds et al. (2014)
Pennsylvania and Indiana, USA | Geurtzen et al. (2014)
California and Netherlands | Kett et al. (2016)
Washington, USA |
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| Aims | To assess the feasibility of simulation to test the effect of maternal race and insurance status on shared decision-making (SDM) in periviable counseling | To compare the contents and styles of counseling as delivered by subjects
from two cultural backgrounds in a highly standardized scenario | To assess whether a written information provided after the prenatal consultation could
improve recall and satisfaction |
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| Study design | Randomized | Nonrandomized | Randomized |
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| Setting | Hospital | Level III neonatal intensive care units | Level III neonatal intensive care unit |
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| Patients/participants | Simulated patients diagnosed with ruptured membranes at 23 weeks | Simulated patient carrying an extremely premature (24 + 6 weeks) fetus | Women at risk of preterm delivery (22–30 weeks) randomized as follows:
N = 18 verbal and written versus N = 18 verbal |
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| Professional | N = 37 obstetricians
N = 15 neonatologists | N = 22 neonatologists (11 American and 11 Dutch) | Neonatologists |
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| Tools applied in counselling | Any | Any | 7-page pamphlet reporting: definition of preterm birth, causes, what to expect in the delivery room, and health problems encountered by preterm infants |
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| Timing and sessions of counselling | Each consult was limited to 30 minutes to eliminate time as a variable | Each consult was limited to 30 minutes to eliminate time as a variable | At imminent preterm labour |
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| Contents of counselling | (i) Outcome data of premature delivery
(ii) Medical care options
(iii) Parents’ goals and values | (i) Survival rates
(ii) Physiologic morbidities
(iii) Options for care: comfort care versus treatment (i.e., partial or maximal life support) | Not described |
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| Style of communication | The level of shared decision-making measured by Braddock scale coding applied to verbatim audio registrations | The consultations were video-recorded and the interpersonal skills were scored using a standardized instrument of coding | No description |
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| Study outcome | The level of SDM | The content and the style of counseling | (i) Recall of the factual information
(ii) Satisfaction with the consultation |
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| Main study results | (i) Information regarding diagnosis and prognosis was heavily emphasized, while attempts to elicit goals and values were often lacking
(ii) SDM occurs differentially based on patients’ race and insurer | (i) American and Dutch neonatologists diverged in the discussed and emphasized options for immediate care in the delivery room | The two groups did not differ in factual recall (within 72 h) or satisfaction with the prenatal consultation |
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