title: Attitudes of Parents and Health Care Workers to Major Surgery for High-Risk Preterm Infants.
abstract: To assess preferences of health care workers (HCWs) and parents of term and preterm infants to adverse health outcomes, and how perceived surgical mortality influences decision-making.
  
  
  
  A total of 536 participants (157 HCWs, 201 parents of term infants, and 178 parents of preterm infants) were recruited to take part in a structured interview. Preferences related to treatment of a critically ill preterm infant with necrotizing enterocolitis were measured by health state rank permutation analysis and pivotal risk analysis. Between-group and subgroup comparisons were performed.
  
  
  
  HCWs rank adverse health states less favorably than parents of preterm infants, consistently ranking 2 of the most adverse health states worse than death. Pivotal risk values of HCWs for all health states were consistently the lowest of the 3 groups. High operative mortality was associated uniformly with reduction in pivotal risks for all groups both in favorable and adverse health states. Subgroup analyses revealed significant discrepancies in preferences between fathers and mothers as well as doctors and nurses. Regular religious practice was significantly associated with increased pivotal risks in parental subgroups.
  
  
  
  As discrepancies in health state preferences existed between subgroups (ie, doctors vs nurses, mothers vs fathers) and perceived operative mortality consistently biased parental and HCW health state preferences, we recommend that HCWs should first identify differences regarding patient management before interviewing the parents together. HCWs should be aware of inadvertently biasing parents when discussing the risks and outcomes of surgery in conjunction with the overall long-term prognosis of the underlying condition.
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Hugh Simon
authors.initials: HS
authors.lastname: Lam
authors.affiliation: Department of Statistics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Tony
authors.initials: T
authors.lastname: Sit
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Chi Lok
authors.initials: CL
authors.lastname: Chau
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Hon Ming
authors.initials: HM
authors.lastname: Cheung
authors.affiliation: Department of Statistics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Samuel Po Shing
authors.initials: SPS
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: pakcheungng@cuhk.edu.hk.
authors.forename: Pak Cheung
authors.initials: PC
authors.lastname: Ng
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006723:Hong Kong; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010290:Parents / Q000523:psychology*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000523:psychology*; D047929:Term Birth
keywords: decision-making; health state ranking; neonatal surgery; pivotal risk