Premature Birth Clinical Trial
Official title:
The Effect of Order of Presenting Survival and Disability Information for Periviable Births on Participant Treatment Choice
Women recruited from the internet were put in a hypothetical situation of being in labor at
22 weeks of pregnancy, and presented with information in the form of pictographs about
survival and disability of babies born at this gestational age.
Participants were randomized to receive these pictographs in a different order (survival or
disability first) and to receive descriptiveness level of survival (just numerical
information, or also description of course of NICU stay).
Participants were then asked to choose between comfort care and intensive care in this
situation. Participants' religiosity, value of the sanctity of life, and health literacy were
also assessed.
The National Institute of Child Health and Human Development (NICHD) Workshop on Periviable
Birth recommended that information on the chance of survival and risk of disability should be
provided separately. The order in which information is presented can affect memory,
persuasiveness, and treatment choice, but the effect of order of information presentation in
the context of neonatal resuscitation has received little attention. Additionally, the effect
of including a description of the long and intense time in the neonatal intensive care unit
(NICU) on parental treatment decision making is also unexplored. Current evidence suggests
that pictographs best convey numerical information to parents.
Three pictographs were developed based on NICHD data for 22 weeks gestational age (GA) babies
who received intensive care. One pictograph displayed information on the rates of disability
in the babies who survive. Two pictographs displayed information about how many babies born
at 22 weeks survive, with one of these pictographs including a description of the average
course of NICU stay.
An internet survey was sent to a U.S. representative sample of women of child-bearing age. A
vignette including background on prematurity and the treatment options of intensive care or
comfort care for a baby born at 22 weeks GA was presented. Participants viewed the
pictographs, evenly randomized to one of four experimental conditions (order of information
presentation x level of description of NICU course). Participants were then asked to choose
intensive care or comfort care. Participant religiosity, values (quality vs. sanctity of
life), autonomy preferences in medical decision making, previous NICU exposure, numeracy, and
health literacy were also assessed.
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