title: A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births.
abstract: BACKGROUND
  Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions.
  
  
  METHODS
  We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?"
  
  
  RESULTS
  Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative.
  
  
  CONCLUSIONS
  Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine.
authors.forename: Brownsyne
authors.initials: B
authors.lastname: Tucker Edmonds
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine.
authors.forename: Fatima
authors.initials: F
authors.lastname: McKenzie
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Panoch
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh School of Medicine.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato
keywords: mechanical ventilation; neonatal intensive care; patient-doctor communication; perinatal palliative care; periviability; shared decision making