Journal of perinatology : official journal of the California Perinatal Association · 2019
Evaluating shared decision-making in periviable counseling using objective structured clinical examinations.
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Tucker Edmonds Brownsyne, McKenzie Fatima, Panoch Janet, Litwiller Abigail, DiCorcia Mark J
Аннотация
OBJECTIVE: To develop and test an Objective Structured Clinical Examination to evaluate the use of shared decision-making (SDM) in periviable counseling among fourth-year OB/GYN residents.
METHODS: Residents counseled a standardized patient presenting with preterm premature rupture of membranes at 23 weeks' gestation. Braddock's 9-item measure of SDM was adapted to a 10-item scoring rubric; rating each: 0 (absent), 1 (partial), or 2 (complete).
RESULTS: Twenty-six residents participated. All provided "complete" discussions of the clinical issue and "complete" or 'partial' ratings for informing the woman of her prognosis (62 and 38%, respectively) and addressing her role in decision-making (42 and 50%). Discussions of her goals and preferences were often absent (69 and 62%). Only 42% discussed uncertainties.
CONCLUSION: Critical elements of SDM related to a woman's values, goals and preferences were not explored when counseling about periviable delivery. Training in SDM is needed to advance communication skills for complex clinical decision-making.
METHODS: Residents counseled a standardized patient presenting with preterm premature rupture of membranes at 23 weeks' gestation. Braddock's 9-item measure of SDM was adapted to a 10-item scoring rubric; rating each: 0 (absent), 1 (partial), or 2 (complete).
RESULTS: Twenty-six residents participated. All provided "complete" discussions of the clinical issue and "complete" or 'partial' ratings for informing the woman of her prognosis (62 and 38%, respectively) and addressing her role in decision-making (42 and 50%). Discussions of her goals and preferences were often absent (69 and 62%). Only 42% discussed uncertainties.
CONCLUSION: Critical elements of SDM related to a woman's values, goals and preferences were not explored when counseling about periviable delivery. Training in SDM is needed to advance communication skills for complex clinical decision-making.