Medical decisions and prognostications of pediatricians for infants with meningomyelocele.
To determine how pediatricians' prognostications and decisions about the treatment of infants with meningomyelocele are affected by varying degrees of hydrocephalus, we randomly selected a sample of pediatricians to receive written surveys. This questionnaire assessed the relationship between the decisions and the prognostications, and compared their accuracy with that of outcome studies. Each pediatrician completed a questionnaire for two of three possible cases, which were identically described as infants with meningomyelocele and complete paraplegia varying only in the degree of hydrocephalus at birth from none to moderate to severe. Recommendations for treatment and prognostications (the Prognostics Belief Scale of Impressions of adult functional capabilities and likely residential and vocational placements) were compared. Significantly fewer pediatricians would present information to parents in an encouraging light, and significantly fewer would treat their own child, if the case involved severe hydrocephalus in comparison with no hydrocephalus. Pediatricians' prognostications were the least optimistic for the infant with severe hydrocephalus and most optimistic for the infant without hydrocephalus, and they were considerably less optimistic than seems justified on the basis of follow-up studies. Last, physicians' less-than-optimistic prognoses were significantly related to their decisions concerning surgery for the infants with moderate and severe hydrocephalus. The major import of the findings is that pediatricians' prognoses reflect, in part, a misconception of the impact of hydrocephalus on children born with meningomyelocele and that these prognoses then have and impact on the pediatricians' decisions concerning treatment.
Siperstein
G N
GN
Center for the Study of Social Acceptance, University of Massachusetts, Boston 02125.
Wolraich
M L
ML
Reed
D
D
O'Keefe
P
P
D003657:Decision Making; D006801:Humans; D006849:Hydrocephalus / Q000150:complications*; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D018579:Patient Selection; D010372:Pediatrics; D011379:Prognosis; D028761:Withholding Treatment