Effects of Description of Options on Parental Perinatal Decision-Making WHAT’S KNOWN ON THIS SUBJECT: Studies have found that the degree of detail with which palliative care is described and the order in which options are presented can affect end-of-life decisions. None of these studies, though, involved decisions regarding very premature infants. WHAT THIS STUDY ADDS: Unlike other end-of-life decisions, those regarding extremely premature infants are influenced neither by the degree of detail nor order of presentation of management options. Deep-seated values embodied in the reasons given for these choices suggest why they are so robust. abstract OBJECTIVE: To examine whether parents’ delivery room management decisions for extremely preterm infants are influenced by (1) the degree of detail with which options (comfort care [CC] or intensive care [IC]) are presented or (2) their order of presentation. METHODS: A total of 309 volunteers, 18 to 55 years old, were each ran- domized to 1 of 4 groups: (1) detailed descriptions, CC presented first; (2) detailed descriptions, IC presented first; (3) brief descriptions, CC presented first; or (4) brief descriptions, IC presented first. Each re- ceived the description of a hypothetical delivery of a 23-week gestation infant and chose either IC or CC. Open-ended and structured questions elicited reasoning. Data were analyzed by x 2 and logistic regression analysis. RESULTS: Neither degree of detail, comparing groups 1+2 with 3+4 (37% vs 41%, odds ratio = 0.85, 95% confidence interval = 0.54–1.34, P = .48), nor order, comparing groups 1+3 with 2+4 (40% vs 37%, odds ratio = 0.88, 95% confidence interval = 0.56–1.39; P = .59), influenced the likelihood of choosing IC. Participants choosing IC were more likely to invoke sanctity of life and religiosity as personal values. Additional reasons for choosing IC were experiences with infants born at later gestational ages, giving the infant a chance, not watching their infant die, and equating CC with euthanasia. Some choosing CC wanted to avoid infant suffering. CONCLUSIONS: The degree of detail and order of presentation had no effect on treatment decisions, suggesting that individuals bring well- articulated preexisting preferences to such decisions. Understanding beliefs and attitudes motivating these preferences can assist physicians in helping parents make informed decisions consistent with their values. Pediatrics 2012;129:891–902 AUTHORS: Marlyse F. Haward, MD, a,b Leslie K. John, PhD, c John M. Lorenz, MD, d and Baruch Fischhoff, PhD c a Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; b Division of Neonatology, Department of Pediatrics, Albert Einstein School of Medicine, Montefiore Medical Center, New York, New York; c Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania; and d Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York KEY WORDS decision-making, extreme prematurity, counseling, palliative care, intensive care ABBREVIATIONS CI—confidence interval DR—delivery room IC—intensive care CC—comfort care OR—odds ratio Dr Haward was responsible for acquisition of data. All authors listed made substantial contributions to the conception and design, analysis, and interpretation of data; to the drafting of the article and revising it critically for important intellectual content; and gave final approval of the version submitted for publication. Dr John’ s current affiliation is Marketing Unit, Harvard Business School, Boston, Massachusetts. www.pediatrics.org/cgi/doi/10.1542/peds.2011-0574 doi:10.1542/peds.2011-0574 Accepted for publication Dec 22, 2011 Address correspondence to Marlyse F. Haward, MD, Division of Neonatology, 1601 Tenbroeck Ave, 2nd Fl Bronx, Weiler Hospital, Bronx NY 10461. E-mail: mhaward@aol.com PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2012 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Supported by the Division of Newborn Medicine at the University of Pittsburgh. PEDIATRICS Volume 129, Number 5, May 2012 891 ARTICLE by guest on February 6, 2016 Downloaded from