Comparison of the attitudes of health care professionals and parents toward active treatment of very low birth weight infants

Abstract

Although pediatricians and neonatal nurses influence parents' treatment decisions, little is known about their attitudes toward active treatment of very low birth weight (VLBW) infants (< 1500 g) and how they compare with parental attitudes. A survey of all 50 pediatricians in Newfoundland (72% response), all 53 neonatal intensive care nurses at the Janeway Child Health Centre (73.6% response), parents of all 144 traceable VLBW infants (72.2% response), and parents of 25 randomly selected normal term infants (60% response), bom in Newfoundland between 1983 and 1987, revealed significant differences in attitudes among parents, nurses, and pediatricians about whether active treatment should be offered to potentially severely handicapped VLBW infants. Most parents of both VLBW and normal term infants (> 80%) agreed, pediatricians were divided, whereas most nurses (79.5%) objected. Both pediatricians and nurses tended to overestimate ( p < 0.05) the morbidity, mortality, and costs of care of VLBW infantsThere was a direct correlation ( p < 0.05) between a negative attitude toward saving VLBW infants and a negatively false perception of neonatal morbidity, mortality, and costs. All groups favored a role for parents and physicians in treatment decisions and objected to a role for regulatory bodies. Pediatricians and nurses also favored a role for nurses and hospital ethics committees but parents disagreed. While most nurses (71%) believed it was unethical to save potentially severely handicapped infants, few pediatricians (36.9%) agreed. Only 27.8% of pediatricians and 10.3% of nurses would seek court intervention if they disagreed with a parental decision not to actively treat a potentially handicapped infant. The results indicate a need for regular updating of physicians and nurses about neonatal outcomes, for increased cognizance of parental desires, and for physicians to be actively involved in treatment decisions.