Peer-reviewed article
Perspectives on anticipated quality-of-life and recommendations for neonatal intensive care: a survey of neonatal providers
OBJECTIVE: Explore associations between neonatal providers' perspectives on survival, quality of life (QOL) and treatment recommendations. METHODS: Providers attending a workshop on neonatal viability were surveyed about survival,…
OBJECTIVE: Explore associations between neonatal providers' perspectives on survival, quality of life (QOL) and treatment recommendations. METHODS: Providers attending a workshop on neonatal viability were surveyed about survival, perceived QOL and treatment recommendations for marginally viable infants. We assessed associations between estimated survival and perceived QOL and treatment recommendations. RESULTS: In the 44 included surveys, estimates of survival and QOL varied widely. Maximum care was recommended 80% of the time when anticipated QOL was high, versus 20% when anticipated QOL was low (p < 0.001). Adjusted for confounders, odds of recommending maximum intervention were 4.4 times higher when anticipated QOL was high (95% CI 1.9 - 10.2, p = 0.001). CONCLUSIONS: The perspectives of practitioners who provide care to critically ill neonates regarding potential survival and QOL vary dramatically and are associated with the treatments those practitioners recommend. Practitioners should take care to avoid basing treatment recommendations on their own perspectives if they are not well aligned with those of the parents.
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About the author
John D. Lantos is a pediatrician and bioethicist writing on AI in medicine, neonatal intensive care, and end-of-life decisions. His essays appear in JAMA, JAMA Pediatrics, the Hastings Center Report, the New England Journal of Medicine, and Aeon. Read more about John.