Exploring implicit bias in the perceived consequences of prematurity amongst health care providers in North Queensland \u2013 a constructivist grounded theory study

Susan Ireland,Robin Ray,Sarah Larkins,Lynn Woodward

doi:10.1186/s12884-021-03539-5

Susan Ireland, Robin Ray + Show 2 more

Open Access

https://doi.org/10.1186/s12884-021-03539-5

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Abstract

BackgroundA study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies.Methods/designApplying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive care for extremely premature babies. These babies are at increased risk of death and neurodisability when compared to babies of older gestations. Participants included HCP of varying disciplines at a large tertiary centre, a regional centre and a remote centre. Staff with a wide range of experience were interviewed.ResultsSix categories of i) who decides, ii) culture and context of families, iii) the life ahead, iv) to treat a bit or not at all, v) following guidelines and vi) information sharing, emerged. Role specific implicit bias was found as a theoretical construct, which depended on the period for which care was provided relative to the delivery of the baby. This implicit bias is an underlying cause for the negativity seen towards extreme prematurity and is presented in this paper. HCP caring for women prior to delivery have a bias towards healthy term babies that involves overestimation of the risks of extreme prematurity, while neonatal staff were biased towards suffering in the neonatal period and paediatricians recognise positivity of outcomes regardless of neurological status of the child. The implicit bias found may explain negativity towards intensive care of periviable neonates.ConclusionUnderstanding the presence and origins of role specific implicit bias may enable HCP to work together to improve care for parents preparing for the delivery of extremely premature babies.

Highlights

A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies
Understanding the presence and origins of role specific implicit bias may enable HCP to work together to improve care for parents preparing for the delivery of extremely premature babies
Implicit bias was expressed by the language used, for example where the parents should be counselled on the ‘right thing to do’ and ‘proper counselling’, both of which were linked to the belief that parents should decline resuscitation below 25 weeks gestation

Summary

Introduction

A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies. There is a higher risk of death and poor neurological outcomes in those who survive compared to those of longer gestation [2,3,4,5]. These babies are often referred to as periviable [1, 6, 7]. From 25 weeks completed gestation, most guidelines used in high income countries suggest that resuscitation should usually occur unless there are specific adverse factors which would increase the risks of a poor outcome. Other countries are recognising improved outcomes at 22 weeks gestation where active care is offered [5, 12, 13]

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