"Doctor, what would you do?": physicians' responses to patient inquiries about periviable delivery.
OBJECTIVE
To qualitatively assess obstetricians' and neonatologists' responses to standardized patients (SPs) asking "What would you do?" during periviable counseling encounters.


METHODS
An exploratory single-center simulation study. SPs, portraying a pregnant woman presenting with ruptured membranes at 23 weeks, were instructed to ask, "What would you do?" if presented options regarding delivery management or resuscitation. Responses were independently reviewed and classified.


RESULTS
We identified five response patterns: 'Disclose' (9/28), 'Don't Know' (11/28), 'Deflect' (23/28), 'Decline' (2/28), and 'Ignore' (2/28). Most physicians utilized more than one response pattern (22/28). Physicians 'deflected' the question by: restating or offering additional medical information; answering with a question; evoking a hypothetical patient; or redirecting the SP to other sources of support. When compared with neonatologists, obstetricians (40% vs. 15%) made personal or professional disclosures more often. Though both specialties readily acknowledged the importance of values in making a decision, only one physician attempted to elicit the patient's values.


CONCLUSIONS
"What would you do?" represented a missed opportunity for values elicitation. Interventions are needed to facilitate values elicitation and shared decision-making in periviable care.


CONCLUSIONS
If physicians fail to address patients' values and goals, they lack the information needed to develop patient-centered plans of care.
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA. Electronic address: btuckere@iupui.edu.
Brownsyne
B
Tucker Edmonds
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA. Electronic address: fmckenzi@iupui.edu.
Fatima
F
McKenzie
Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA. Electronic address: jpanoch@iupui.edu.
Janet E
JE
Panoch
Fairbanks Center for Medical Ethics, Indianapolis, USA. Electronic address: lwocial@iuhealth.org.
Lucia D
LD
Wocial
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA. Electronic address: barnatoae@upmc.edu.
Amber E
AE
Barnato
Mary Margaret Walther Center for Research and Education in Palliative Care, IU Simon Cancer Center, Indianapolis, USA. Electronic address: rfrankel@iupui.edu.
Richard M
RM
Frankel
D000328:Adult; D000368:Aged; D003142:Communication; D003376:Counseling; D003657:Decision Making; D005260:Female; D005328:Fetal Viability; D006801:Humans; D007196:Indiana; D008297:Male; D008875:Middle Aged; D009359:Neonatology; D009774:Obstetrics; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D012959:Socioeconomic Factors; D014741:Video Recording
Doctor–patient communication; Neonatal resuscitation; Periviability