title: Comparing neonatal morbidity and mortality estimates across specialty in periviable counseling.
abstract: OBJECTIVE
  To describe and compare estimates of neonatal morbidity and mortality communicated by neonatologists and obstetricians in simulated periviable counseling encounters.
  
  
  METHODS
  A simulation-based study of 16 obstetricians (OBs) and 15 neonatologists counseling standardized patients portraying pregnant women with ruptured membranes at 23 weeks gestation. Two investigators tabulated all instances of numerically-described risk estimates across individuals and by specialty.
  
  
  RESULTS
  Overall, 12/15 (80%) neonatologists utilized numeric estimates of survival; 6/16 (38%) OBs did. OBs frequently deferred the discussion of "exact numbers" to neonatologists. The 12 neonatologists provided 13 unique numeric estimates, ranging from 3% to 50% survival. Half of those neonatologists provided two to three different estimates in a single encounter. By comparison, six OBs provided four unique survival estimates ("50%", "30-40%", "1/3-1/2", "<10%"). Only 2/15 (13%) neonatologists provided numeric estimates of survival without impairment. None of the neonatologists used the term "intact" survival, while five OBs did. Three neonatologists gave numeric estimates of long-term disability and one OB did.
  
  
  CONCLUSIONS
  We found substantial variation in estimates and noteworthy omissions of discussions related to long-term morbidity. Across specialties, we noted inconsistencies in the use and meaning of terms like "intact survival." More tools and training are needed to improve the quality and consistency of periviable risk-communication.
authors.affiliation: a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA .
authors.forename: Brownsyne
authors.initials: B
authors.lastname: Tucker Edmonds
authors.affiliation: a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA .
authors.forename: Fatima
authors.initials: F
authors.lastname: McKenzie
authors.affiliation: a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA .
authors.forename: Janet E
authors.initials: JE
authors.lastname: Panoch
authors.affiliation: b Mary Margaret Walther Center for Research and Education in Palliative Care, IU Simon Cancer Center , Indianapolis , IN , USA .|c Roudebush Veterans Affairs Medical Center , Indianapolis , IN , USA , and.|d Department of Medicine , Indiana University School of Medicine , Indianapolis , IN , USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data; D003376:Counseling / Q000379:methods / Q000592:standards; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005328:Fetal Viability; D006801:Humans; D007196:Indiana; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009359:Neonatology; D009774:Obstetrics; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D014342:Truth Disclosure
keywords: Doctor–patient communication; extreme prematurity; periviability; risk-communication