Evaluating the Use of a Decision Aid for Parents Facing Extremely Premature Delivery: A Randomized Trial

Abstract

Objective: To assess decisional conflict and knowledge about prematurity among mothers facing extreme premature delivery when the counseling clinicians were randomized to counsel using a validated decision aid compared with usual counseling.

Study design: In this randomized trial, clinicians at 5 level III neonatal intensive care units in the US were randomized to supplement counseling using the decision aid or to counsel mothers in their usual manner. We enrolled mothers with threatened premature delivery at 22^0/7 to 25^6/7 weeks of gestation within 7 days of their counseling. The primary outcome was the Decisional Conflict Scale (DCS) score. One hundred mothers per group were enrolled to detect a clinically relevant effect size of 0.4 in the Decisional Conflict Scale. Secondary outcomes included knowledge about prematurity; scores on the Preparedness for Decision Making scale; and acceptability.

Results: Ninety-two clinicians were randomized and 316 mothers were counseled. Of these, 201 (64%) mothers were enrolled. The median gestational age was 24.1 weeks (IQR 23.7-24.9). In both groups, DCS scores were low (16.3 ± 18.2 vs 16.8 ± 17, P = .97) and Preparedness for Decision Making scores were high (73.4 ± 28.3 vs 70.5 ± 31.1, P = .33). There was a significantly greater knowledge score in the decision aid group (66.2 ± 18.5 vs 57.2 ± 18.8, P = .005). Most clinicians and parents found the decision aid useful.

Conclusions: For parents facing extremely premature delivery, use of a decision aid did not impact maternal decisional conflict, but it significantly improved knowledge of complex information. A structured decision aid may improve comprehension of complex information.

Trial registration: Clinicaltrials.gov: NCT01713894.

Keywords: decision aids; decision making; extremely premature; infant.

Figure 1:

Decision aid for counseling parents facing extreme prematurity

Figure 2:

Flow Diagram * Of the 92 clinicians randomized, 12 in the routine counseling and 19 in the DA group did not perform any consults during the study ¥ GA at delivery was unknown for 9 mothers in the routine counseling group and 2 mothers in the DA group ^ survival defined as survival to hospital discharge. 4 sets of twins delivered in the routine counseling group and 1 set of twins, 1 set of triplets, and 1 set of quadruplets delivered in the DA group; IUFD: intrauterine fetal demise