73: Participation of Parents in a Shared Decision-Making Process: Antenatal Consultation at the Limits of Viability
Bibliographic record
Abstract
Critical decisions regarding infants at risk of being born at the limits of viability are primarily discussed during the antenatal consultation with a Neonatologist. These decisions are emotionally unthinkable; choosing between intensive care to support survival or palliative care. One the one hand, we don't know whether the baby will survive, and if it survives, will the baby be significantly handicapped; on the other hand, certain death. Each participant of the antenatal consultation, the parents and the neonatologist, carry their own values to define the best interest of the infant that will support the final decision. Even though shared decision-making is promoted by professional societies, the parents might not participate as they expect. Moreover, the neonatologist might inaccurately estimate the parents desire to participate or limit the parents' authority to make decision. In those circumstances, open communication between the parents and the neonatologist is essential. However, the most effective strategies for communication and encouragement of parent participation are unknown. The goals of this study are to explore the communication between the parents and the neonatologist and to describe the factors that promote parent satisfaction in their participation in the decision-making process. We conducted a qualitative study based on ethno-methodology to analyze videotapes of the interactions between parents and neonatologists during the antenatal consultation. Post-antenatal consultation interviews were used to define parent satisfaction scores for their participation during interaction. Five system – infant at risk including 10 parents and six neonatologists participated in the study. Results highlight key factors such as sharing ‘weighted’ information, offering choices, allowing time to think and building trustworthy parent-doctor relationships through communication promote the opportunity for parents to participate. Important communication behaviours including empathy, support and listening, taking turns as “expert” facilitate parent participation in the decision making process. The key factors were integrated in a model to facilitate parents' participation in the decision making to their satisfaction (Figure). From this model we identified specific communication strategies examples useful to the neonatologist that will support parents in their participation in a true shared decision-making process
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".