The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study
Abstract Background In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. Methods This study employed...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-12-01
|
| Series: | Maternal Health, Neonatology and Perinatology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40748-023-00168-y |
| _version_ | 1797414217144336384 |
|---|---|
| author | Megan J. Thorvilson Katherine Carroll Bethany D. Kaemingk Karen S. Schaepe Christopher A. Collura |
| author_facet | Megan J. Thorvilson Katherine Carroll Bethany D. Kaemingk Karen S. Schaepe Christopher A. Collura |
| author_sort | Megan J. Thorvilson |
| collection | DOAJ |
| description | Abstract Background In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. Methods This study employed a qualitative study design using inductive thematic discourse analysis of ‘naturally occurring data’ in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists’ discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. Results In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus’s presence, and (iii) fetal role in decision-making. Conclusion Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM. |
| first_indexed | 2024-03-09T05:29:53Z |
| format | Article |
| id | doaj.art-035bba8da49d406c835481f179620368 |
| institution | Directory Open Access Journal |
| issn | 2054-958X |
| language | English |
| last_indexed | 2024-03-09T05:29:53Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Maternal Health, Neonatology and Perinatology |
| spelling | doaj.art-035bba8da49d406c835481f1796203682023-12-03T12:33:21ZengBMCMaternal Health, Neonatology and Perinatology2054-958X2023-12-01911810.1186/s40748-023-00168-yThe use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative studyMegan J. Thorvilson0Katherine Carroll1Bethany D. Kaemingk2Karen S. Schaepe3Christopher A. Collura4Department of Pediatric and Adolescent Medicine, Mayo ClinicSchool of Sociology, College of Arts and Social Sciences, Australian National UniversityDepartment of Pediatric and Adolescent Medicine, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicDepartment of Pediatric and Adolescent Medicine, Mayo ClinicAbstract Background In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. Methods This study employed a qualitative study design using inductive thematic discourse analysis of ‘naturally occurring data’ in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists’ discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. Results In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus’s presence, and (iii) fetal role in decision-making. Conclusion Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM.https://doi.org/10.1186/s40748-023-00168-yProjected autonomyPrenatal careDecision makingNeonatologists |
| spellingShingle | Megan J. Thorvilson Katherine Carroll Bethany D. Kaemingk Karen S. Schaepe Christopher A. Collura The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study Maternal Health, Neonatology and Perinatology Projected autonomy Prenatal care Decision making Neonatologists |
| title | The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study |
| title_full | The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study |
| title_fullStr | The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study |
| title_full_unstemmed | The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study |
| title_short | The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study |
| title_sort | use of projected autonomy in antenatal shared decision making for periviable neonates a qualitative study |
| topic | Projected autonomy Prenatal care Decision making Neonatologists |
| url | https://doi.org/10.1186/s40748-023-00168-y |
| work_keys_str_mv | AT meganjthorvilson theuseofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT katherinecarroll theuseofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT bethanydkaemingk theuseofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT karensschaepe theuseofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT christopheracollura theuseofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT meganjthorvilson useofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT katherinecarroll useofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT bethanydkaemingk useofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT karensschaepe useofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy AT christopheracollura useofprojectedautonomyinantenatalshareddecisionmakingforperiviableneonatesaqualitativestudy |