Decision-making at the limit of viability: the Austrian neonatal choice context

Choice context influences decision processes, and is one of the primary determinants of what people choose. This insight has been used by academics and practitioners to study decision biases and design behavioral interventions to influence and improve choices. In this paper we analyze the effects of context-based behavioral interventions on the computational mechanisms underlying decision making. We collect data from two very large laboratory studies involving nineteen prominent behavioral interventions, and model the influence of each intervention using a leading computational model of choice in psychology and neuroscience. This allows us to parametrize the biases induced by each intervention, interpret these biases in terms of underlying decision mechanisms and their properties, quantify similarities between interventions, and predict how different interventions alter key choice outcomes. In doing so, we offer researchers and practitioners a theoretically principled approach to understanding and manipulating choice context in decision making.

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Decision-making at the limit of viability

Minerva Pediatrics ◽

10.23736/s2724-5276.20.05825-9 ◽

2021 ◽

Vol 73 (4) ◽

Author(s):

Ana LEMOS ◽

Henrique SOARES ◽

Hercília GUIMARÃES

Keyword(s):

Decision Making ◽

Limit Of Viability

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Correction to: Decision-making at the limit of viability: differing perceptions and opinions between neonatal physicians and nurses

BMC Pediatrics ◽

10.1186/s12887-019-1890-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hans Ulrich Bucher ◽

◽

Sabine D. Klein ◽

Manya J. Hendriks ◽

Ruth Baumann-Hölzle ◽

...

Keyword(s):

Decision Making ◽

Limit Of Viability

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Protect us from ourselves: Balancing the parental instinct of saving

Nursing Ethics ◽

10.1177/0969733019871691 ◽

2019 ◽

Vol 27 (5) ◽

pp. 1282-1296

Author(s):

Lars Ursin ◽

Janicke Syltern

Keyword(s):

Decision Making ◽

Research Question ◽

Ethical Challenges ◽

Prenatal Counselling ◽

Limit Of Viability ◽

Regional Committee ◽

Role Of Parents ◽

Study Participants ◽

Medical Research Ethics

Background Neonatologists, legal experts and ethicists extensively discuss the ethical challenges of decision-making when a child is born at the limit of viability. The voices of parents are less heard in this discussion. In Norway, parents are actively shielded from the burden of decision-making responsibility. In an era of increasing patient autonomy, is this position still defendable? Research question In this article, we discuss the role of parents in neonatal decision-making, based on the following research question: Should parents decide whether to provide lifesaving treatment when their child is born at the limit of viability? Research design We conducted eight interviews with 12 parents, 4 individuals and 4 couples, all having experienced prenatal counselling at the limit of viability. The interviews took place at different university locations in Norway in the years 2014–2018. Ethical considerations All study participants gave their written informed consent. The Regional Committee for Medical Research Ethics approved the study. Findings We identified six main themes in parents’ responses to the research question. Parents (1) experienced an emotional turmoil confronted with birth at the border of viability, (2) emphasized the importance of being involved in decision-making, (3) described and reflected on the need to balance the parental instinct of saving, (4) were concerned about the dilemmas involved in protecting the family, (5) were worried about the burden of overwhelming responsibility and (6) called for guideline relief. Conclusion The perceived parental instinct of saving the life of their child makes it hard for parents to step away from a call for ‘everything to be done’. Involvement of an interprofessional periviability team drawing on the experiences and viewpoints of nurses and neonatologists in decision-making is needed to protect both infants and parents against undue parental push for treatment and enable parents to make good decisions regarding their child.

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Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability

American Journal of Perinatology ◽

10.1055/s-0040-1719071 ◽

2020 ◽

Author(s):

Kaitlyn Arbour ◽

Elizabeth Lindsay ◽

Naomi Laventhal ◽

Patrick Myers ◽

Bree Andrews ◽

...

Keyword(s):

Decision Making ◽

Endotracheal Tube ◽

Gestational Age ◽

The United States ◽

Delivery Room ◽

Provider Attitudes ◽

Comfort Care ◽

Palliative Care Teams ◽

Institutional Resources ◽

Limit Of Viability

Objective This study aimed to provide contemporary data regarding provider perceptions of appropriate care for resuscitation and stabilization of periviable infants and institutional resources available to providers. Study Design A Qualtrics survey was emailed to 672 practicing neonatologists in the United States by use of public databases. Participants were asked about appropriate delivery room care for infants born at 22 to 26 weeks gestational age, factors affecting decision-making, and resources utilized regarding resuscitation. Descriptive statistics were used to analyze the dataset. Results In total, 180 responses were received, and 173 responses analyzed. Regarding preferred course of care based on gestational age, the proportion of respondents endorsing full resuscitation decreased with decreasing gestational age (25 weeks = 99%, 24 = 64%, 23 = 16%, and 22 = 4%). Deference to parental wishes correspondingly increased with decreasing gestational age (25 weeks = 1%, 24 = 35%, 23 = 82%, and 22 = 46%). Provision of comfort care was only endorsed at 22 to 23 weeks (23 weeks = 2%, 22 = 50%). Factors most impacting decision-making at 22 weeks gestational age included: outcomes based on population data (79%), parental wishes (65%), and quality of life measures (63%). Intubation with a 2.5-mm endotracheal tube (84%), surfactant administration in the delivery room (77%), and vascular access (69%) were the most supported therapies for initial stabilization. Availability of institutional resources varied; the most limited were obstetric support for cesarean delivery at the limit of viability (37%), 2.0-mm endotracheal tube (45%), small baby protocols (46%), and a consulting palliative care teams (54%). Conclusion There appears to be discordance in provider attitudes surrounding preferred actions at 23 and 22 weeks. Provider attitudes regarding decision-making at the limit of viability and identified resource limitations are nonuniform. Between-hospital variations in outcomes for periviable infants may be partly attributable to lack of provider consensus and nonuniform resource availability across institutions. Key Points

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