Grants

"Parents at risk for delivery during the periviable period face the extraordinary challenge of thinking about the end of life at what should be the beginning. We are developing a decision support tool to help patients and health care providers improve shared decision making during this difficult time.??? - Katherine P. Himes, MD, MS, Magee-Womens Hospital of UPMC

DEVELOPMENT OF A TOOL TO SUPPORT SHARED DECISION MAKING BETWEEN CLINICIANS AND FAMILIES AT RISK OF PERIVIABLE DELIVERY

Grant Application

Katherine P. Himes, MD, MS, Magee-Womens Hospital of UPMC and UPP Women’s Health

 

Proposed Innovation

Parents who deliver during the periviable (extremely premature) period face the extraordinary challenge of participating in decisions about whether to use life support for their infant(s) born on the cusp of viability. Families must grasp complex medical information about their baby’s immediate prognosis and risk for significant long-term morbidity. Compounding the situation, parents often have to arrive at treatment decisions quickly as clinical situations evolve rapidly. Although these decisions are among the most important parents will face, a number of studies have identified shortcoming in the counseling families receive that threatens the quality of decision making and may contribute to patient anxiety. Moreover, there are no validated strategies to improve decision making in this clinical context.

This project aims to address this gap by developing a tablet-based decision support tool to improve shared decision making by families facing delivery of extremely premature infants.

 

Improvements in Action

The tool will address shortcomings in communication between clinicians and families facing periviable delivery that can compromise the shared decision making process. This will be achieved by:

  • Providing standardized information regarding infant survival and long-term outcomes
  • Using video and simple graphics to communicate complex issues
  • Conducting values clarification exercises to help patients reach decisions that reflect their values
  • Providing supplemental resources for families to access after meeting with the medical team

 

Results – In Progress

The decision support tool is expected to improve a number of aspects of decision making for pregnant patients facing periviable delivery. Providing consistent and understandable information about immediate and long-term prognosis — along with values exercises — will help families participate in shared decision making and arrive at decisions that reflect their values.