Periviability decision making: assessing provider traits and cognitive skills

To investigate MFM physicians’ approach to periviable delivery management and examine whether personal traits, practice characteristics, or cognitive skills are associated with these approaches. Cross-sectional study of SMFM Regular and Fellow members (10/2016-5/2017). A web-based survey queried recommendations for periviable delivery management based on eight scenarios (PPROM or advanced cervical dilation at 19, 21, 23, or 25 weeks). Respondents were surveyed on personal/practice characteristics and cognitive skills, including coping skills and tolerance of ambiguity, using validated instruments. Responses to scenarios were summarized as “willingness to intervene” and “willingness to recommend termination” scores. We performed a planned subgroup analysis of the 21-week scenarios, a point considered by some to have clinical equipoise. Top quartile scores were compared with those in the lower three using bivariable and multivariable analyses. Primary analysis assessed association of recommendations with cognitive skills. Secondary analyses included assessment of recommendations with provider personal/practice traits. Of 202 respondents, mean age was 45.5y (±11.4) and 68.7% were female. Characteristics associated with top quartile of willingness to intervene included greater willingness to consider cerclage for self or loved one (76.9% vs 45.5%, p<0.001). Characteristics associated with top quartile for willingness to recommend termination included less willingness to consider cerclage for self or loved one (26.7% vs 69.4%, p<0.001) and residence in the West or Northeast (p=0.037). Race, gender, age, practice type, training, and cognitive scores were not associated with intervention or termination recommendations. At 21 weeks, MFMs in the Northeast and West were more likely to recommend termination; those in the South were more likely to recommend intervention (p=0.037). MFMs who scored in the top quartile for coping skills were more likely to recommend termination than those in the bottom quartiles (88% vs 50%, p=0.017), a finding which persisted after controlling for region of practice (aOR 7.3, 95% CI 1.6-33.0). MFM recommendations for management of pregnancies at risk of periviable delivery vary by provider traits including practice region, willingness to consider cerclage for self or loved one, and coping skills.View Large Image Figure ViewerDownload Hi-res image Download (PPT)