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Default options and neonatal resuscitation decisions.
MedLine Citation:
PMID:  23180252     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants.
MATERIALS AND METHODS: Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression.
RESULTS: Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate.
DISCUSSION: Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy.
CONCLUSION: Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.
Authors:
Marlyse Frieda Haward; Ryan O Murphy; John M Lorenz
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of medical ethics     Volume:  38     ISSN:  1473-4257     ISO Abbreviation:  J Med Ethics     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513619     Medline TA:  J Med Ethics     Country:  England    
Other Details:
Languages:  eng     Pagination:  713-8     Citation Subset:  E; IM    
Affiliation:
Neonatal Office, The Valley Hospital, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA. mhaward@aol.com.
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