681 Parent and professional alignment in periviable pre-delivery conversations: a qualitative analysis

Objectives

Pre-birth decision-making conversations between clinicians and parents facing periviable delivery (22+0 – 24+6 weeks) are complex and emotive for all involved. Professional guidance does not adequately address the content of these life-changing conversations. This qualitative study aimed to establish parent and clinician perspectives and priorities for the content and conduct of pre-birth periviable conversations.

Method

This study used semi-structured interviews to gather data. We have conducted 13 interviews with 14 parents and clinicians from the North West of England. Interviews were conducted across a mixture of perinatal medical specialities and across parental experiences (table 1). Parents of surviving infants were contacted by post by the research team. Bereaved parents were contacted via their bereavement team. Data was analysed using reflexive thematic analysis of the transcribed interviews. This study was devised in collaboration with our regional parent support group. The interview questions were written following parent group discussion, and adapted based on the group’s feedback.

Results

Three key themes have been established: Gap between perception of amount of information shared. Parents report difficulty in accessing pertinent, detailed information. Whilst clinicians reported concern about overloading parents and parental comprehension. Conflicting information provided by different members of the perinatal team. Lack of consistent and reliable information for parents. Response to uncertainty: A dichotomy exists between parental maintenance of hope versus clinician pessimism when faced with uncertainty about individual infant outcome.

Conclusions

Current systems mean parents often encounter information about periviable delivery only if they present in threatened periviable labour. They are reliant on the information discussed with them by their treating perinatal team. Our data show variation in the approach to, and, perception of, these conversations between different perinatal clinicians. Given that at periviability, there is a decision to be made about how appropriate active intervention at birth is, this variation in communication of management options and outcomes may limit parent autonomy and access to care.