Factors influencing medical prognostication of high-risk pregnancies

Research team

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)

Funding

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.

 

Publications

Rasmussen, L.A., Cascio, A., Ferrand, A., Shevell, M., Racine, E. (2019). The Complexity of Physicians’ Understanding and Management of Prognostic Uncertainty in Neonatal Hypoxic-Ischemic Encephalopathy. Journal of Perinatology, Nature, 39(2): 278-285.

Ferrand, A., Racine, E. (2018). Can Clinicians be Objective? Inherent Challenges in Using Decision-making Tools in Cases of Entrenched Disagreements. American Journal of Bioethics, 18(8): 80-82. Read article.

Ferrand, A., Gorgos, A., Ali, N., & Payot, A. (2018). Resilience rather than medical factors: How parents predict quality of life of their sick newborn. J Pediatr. doi: 10.1016/j.jpeds.2018.05.025. Read article.

Racine, E., Bell, E., Farlow, B., Miller, S., Payot, A., Rasmussen, L. A., Shevell, M. I., Thomson, D., & Wintermark, P. (2017). The ‘ouR‐HOPE’ approach for ethics and communication about neonatal neurological injury. Development Medicine & Child Neurology, 59(2), 125-135. Read article.

Rasmussen, L. A., Bell, E., & Racine, E. (2016). A qualitative study of physician perspectives on prognostication in neonatal hypoxic ischemic encephalopathy. Journal of Child Neurology, 31(11), 1312-1319. Read article.

Bell, E., Rasmussen, L. A., Mazer, B., Shevell, M., Miller, S. P., Synnes, A., Yager, J. Y., Majnemer, A., Muhajarine, N., Chouinard, I., & Racine, E. (2014). Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic‐ischemic injury: A vignette‐based study of Canadian specialty physicians. Journal of Child Neurology, 30(2), 174–81. Read article.

Racine, E., Dion, M-J., Wijman, C. A. C., Illes, J., & Lansberg, M. (2009). Profiles of neurological outcome prediction among intensivists. Neurocritical Care, 11(3), 345-352. Read article.

Racine, E., & Shevell, M. (2009). Ethics in neonatal neurology; “When is enough, enough?” Pediatric Neurology, 40(3), 147-155. Read article.