title: Use of a visual aid to improve counseling at the threshold of viability.
abstract: OBJECTIVE
  To pilot-test a visual aid developed to help counsel pregnant women.
  
  
  METHODS
  After agreeing to participate, pregnant women at >28 weeks of gestation were assigned randomly to counseling with or without a visual aid. The visual aid contained pictures, graphics, and short messages about delivery room resuscitation, chances of survival, anticipated neonatal course, and long-term neurodevelopmental disabilities. A neonatal fellow performed counseling with a standardized script for an anticipated delivery at 23 weeks of gestation. In precounseling and postcounseling sessions, women were given a structured interview to assess their knowledge of chances of survival and disability and attitudes toward resuscitation.
  
  
  RESULTS
  Of the 89 women who participated, 76% were black and 59% read below a 9th-grade level. Compared with the no-visual aid group, women in the visual aid group recalled more disabilities and predicted longer neonatal stays (P = .01). For both groups, mothers' perceptions of the chances of survival were lower after counseling; the decrease was greater in the visual aid group (P = .03). The majority of women in each group opted for resuscitation, which was not affected by counseling. In multivariate analyses, use of the visual aid was a significant independent factor in explaining before/after differences in survival chances and recall of a long NICU stay and number of disabilities; higher literacy levels also were significant for recalling the number of disabilities.
  
  
  CONCLUSIONS
  Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.
authors: University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA. venkat.kakkilaya@utsouthwestern.edu
authors: Venkatakrishna
authors: V
authors: Kakkilaya
authors: Lynn J
authors: LJ
authors: Groome
authors: Daci
authors: D
authors: Platt
authors: Dalibor
authors: D
authors: Kurepa
authors: Arun
authors: A
authors: Pramanik
authors: Gloria
authors: G
authors: Caldito
authors: Lesley
authors: L
authors: Conrad
authors: Joseph A
authors: JA
authors: Bocchini
authors: Terry C
authors: TC
authors: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D001296:Audiovisual Aids; D003376:Counseling / Q000379:methods*; D005260:Female; D005328:Fetal Viability; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D047928:Premature Birth; D055815:Young Adult