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Obstetric Quality and Safety

Poster Session 3

(779) Patient Perspectives on Sources of Conflict and Support During Periviability Counseling: A Qualitative Analysis

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Families facing delivery during the periviable period must make high-stakes, time-sensitive, and often irrevocable decisions about how to care for their infant after birth. There is a paucity of literature regarding patients’ experiences with periviable counseling. Understanding patient experience can help us improve communication and may aid high-quality decision making. The purpose of this study was to highlight patient-identified sources of support and conflict from conversations with their health care team when delivering during the periviable period. 

Study Design: We contacted birthing people who delivered between 22 - 25 weeks gestational age from 2011 - 2014. We conducted semi-structured interviews focused on counseling and decision-making at the time of periviable birth. Interviews were transcribed and coded to perform thematic analysis.

Results: We interviewed 20 women who delivered during the periviable period and 6 important others. Average age was 27.3, 35% identified as Black and 50% had private insurance. The average gestational age at delivery was 24 weeks. We identified 14 themes during our analysis. Here, we focus on sources of conflict and support which were most frequently coded and actionable. Sources of conflict included a mismatch between patients’ and providers’ understanding of prognosis, patient perception of excessive hopelessness by providers, and lack of provider acknowledgement of family values. Sources of support included relationships with and understanding from nursing and ancillary staff, providers acknowledging family emotional processing, as well as patient’s perception of time and effort spent by provider.

Conclusion: Our findings suggest areas for improvement in our periviablity counseling include provider acknowledgement of patient hope and family values, whilst ensuring patient understanding of prognosis. Our findings emphasize adequate time for counseling and addressing patient emotions throughout, with potential benefit in providing nursing training in patient support during the periviable period.