Maria Gillam-Krakauer
Vanderbilt University
Background: There is a need for periviability (22 – 24 weeks) counseling curricula to teach updated outcomes and personalized decision making (PDM). The effect of a curriculum on knowledge and attitudes of providers towards resuscitating infants at the margins of viability is unknown.
Objectives: The primary aim was to determine effect of the curriculum upon knowledge. Secondary aims were to determine effect on attitudes towards resuscitation and differences between faculty and fellows. It was hypothesized that the curriculum would improve knowledge and develop more favorable attitudes towards resuscitation in the periviable period.
Methods: A curriculum was created to teach survival and outcomes data, bias recognition, and PDM. Prior to implementation, fellows and faculty completed a knowledge and attitude survey. Fellows participated 4 thematic workshops and a post-survey and 3 counseling simulations pre/post.
Fellow responses were compared to faculty responses using Pearson and Wilcoxon tests. Change in fellow responses was compared with regular or ordinal logistic regression with robust covariance matrix estimates.
Results: Fellow and faculty differed on reported local survival at 23 weeks, with faculty underestimating survival. Fellows overestimated major morbidity at 24-26 weeks with significant improvement in this area post-intervention.
At 23 weeks 58% of providers agreed that resuscitation at birth should be offered, this rose to 89% at 24 weeks.
Conclusion: The counseling curriculum resulted in improved knowledge but did not change attitudes towards resuscitation at 22-24 weeks’ gestation. Providers overestimate major morbidity which may influence attitudes. Attitude change techniques might be required to change attitudes towards resuscitation.
