Factors influencing medical prognostication of high-risk pregnancies
Amaryllis Ferrand, MD (Pragmatic Health Ethics Research Unit, Université de Montréal); Antoine Payot, MD, PhD (Université de Montréal); Eric Racine, PhD (Pragmatic Health Ethics Research Unit, Université de Montréal, McGill University)
Vanier Canada Graduate Scholarship (CIHR)
Some pregnancies are complicated by findings of congenital malformations in the fetus or a risk of premature delivery. Parents living these unfortunate situations must sometimes take difficult decisions, such as continuing the pregnancy or not, or deciding what level of care should their newborn child should receive. Parents are supported in those decisions by physicians such as obstetricians and neonatologists that counsel them by sharing their predictions regarding the survival chances of their child-to-be-born, disability and future quality of life.
These future predictions, called prognoses, can be very different from one physician to another, and even sometimes erroneous. These discrepancies can be explained by the presence of multiple factors influencing the prognostic. These factors can be associated with patient’s characteristics (for example ethnic background, age), the physician’s values (for example personal beliefs, psychological state) or the context (for example the timing of the meeting, the number of people present at the meeting). It is important to understand what the influence of these factors on the physician’s prognosis is since this prognosis may impact parents’ irreversible decisions regarding their child-to-be-born. This project aims to study the psychological and environmental factors influencing prognosis in obstetricians and neonatologists meeting with families in antenatal consultations.
Racine Eric, Bell Emily, Farlow Barbara, Miller Steven, Payot Antoine, Rasmussen Lisa Anne, Shevell Michael, Thomson Donna, Wintermark Pia. “ouR-HOPE” approach for ethics and communication about neonatal neurological injury. Developmental Medicine & Child Neurology, 2017; 59(2), 125-135.Publications
Rasmussen Lisa Anne, Cascio Ariel, Ferrand Amaryllis, Shevell Michael, Racine Eric. The complexity of physicians’ understanding and management of prognostic uncertainty in neonatal hypoxic-ischemic encephalopathy. Journal of Perinatology, 2018; 39:278–285. Read article.
Ferrand Amaryllis, Racine Eric. Can clinicians be objective? Inherent challenges in using decision-making tools in cases on entrenched disagreements. American Journal of Bioethics, 2018; 18(8):80-82. Read article.
Ferrand Amaryllis, Gorgos Andreea, Ali Nabeel, Payot Antoine. Resilience Rather than Medical Factors: How Parents Predict Quality of Life of Their Sick Newborn. The Journal of Pediatrics, 2018; 200:64-70.e5. Read article.
Racine Eric, Bell Emily, Farlow Barbara, Miller Steven, Payot Antoine, Rasmussen Lisa Anne, Shevell Michael, Thomson Donna, Wintermark Pia. “ouR-HOPE” approach for ethics and communication about neonatal neurological injury. Developmental Medicine & Child Neurology, 2017; 59(2), 125-135. Read article.
Rasmussen Lisa Anne, Bell Emily, Racine Eric. A qualitative study of physician perspectives on prognostication in neonatal hypoxic ischemic encephalopathy. Journal of Child Neurology, 2016; 31(11), 1312-1319. Read article.
Bell Emily, Rasmussen Lisa Anne, Mazer Barbara, Shevell Michael, Miller Steven P., Synnes Anne, Yager Jerome Y., Majnemer Annette, Muhajarine Nazeem, Chouinard Isabelle, Racine Eric. Magnetic Resonance Imaging (MRI) and prognostication in neonatal hypoxic ischemic injury: A vignette-based study of Canadian specialty physicians. Journal of Child Neurology, 2015; 30(2), 174-181. Read article.
Racine Eric, Dion Marie-Josée, Wijman Christine A.C., Illes Judy, Lansberg Maarten. Profiles of neurological outcome prediction among intensivists, Neurocritical Care, 2009; 11(3), 345-352. Read article.
Racine Eric and Shevell Michael. Ethics in neonatal neurology; “When is enough, enough?”. Pediatric Neurology 2009; 40(3), 147-155. Read article.