Abstract
BackgroundDecision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants.MethodsWe developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.ResultsThe DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).ConclusionWe have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice.
Highlights
Decision Aids (DA) are well established in various fields of medicine
Patent ductus arteriosus (PDA) is very common among very low birth weight infants (VLBW), the delay in closure of the ductus is inversely related to gestational age varying from 20% in premature infants greater than 32 weeks up to 60% in extreme low birth weight infants (ELBW < 1000 g) [1,2]
The Decision Aid (DA) Structure DA was structured in two parts; the first part provides medical information about: the use of the DA, prematurity and its complications, PDA, and the use of indomethacin therapy in ELBW infants, chance of intermediate outcomes, chance of long term outcomes for both options, and potential adverse effects associated with indomethacin prophylaxis use, all presented in a systematic and balanced way through a series of screen shots, that included several images and simplified language in both paragraphs and bullet points
Summary
Decision Aids (DA) are well established in various fields of medicine It can improve the quality of decision-making and reduce decisional conflict. We aimed to develop a DA that elicits parents’ preferences with regard to indomethacin therapy in ELBW infants. Observational data confirmed an association of PDA with the subsequent development of bronchopulmonary dysplasia (BPD) in premature infants [4,5]. Large left to right ductal shunting is associated with a significant increase in pulmonary blood flow and serious pulmonary hemorrhage [9,10]. In addition a recent ancillary analysis on the database of the trial of indomethacin prophylaxis in the preterm infants (TIPP trial), showed a significant reduction of serious clinically significant pulmonary hemorrhage during the first week of life [13]
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