Evaluating How Beliefs Among Pediatric Cardiology Providers May Affect Fetal Cardiac Counseling-A National Perspective.

Abstract

Background: Prenatal counseling following a fetal diagnosis of critical congenital heart disease (CCHD) is challenging and requires delivery of detailed and complete information to ensure appropriate decision making and pregnancy support.

Methods: An anonymous 50-item survey was distributed to providers who performed fetal cardiac counseling. The primary purpose was to evaluate on a national scale physician beliefs and attitudes toward available choices after a fetal diagnosis of CCHD and their association with reported counseling practices. Participants were specifically asked to indicate how likely they were to recommend postnatal interventional and/or surgical treatment, postnatal palliative care, or termination of pregnancy. The primary outcome variables were provider responses to statements about pregnancies complicated by CCHD diagnosed in utero.

Results: There were 138 respondents, with most somewhat or strongly agreeing that providing counseling on surgical and catheter-based interventions anticipated in the short- and long-term (99%, 136/138), counseling on a "comfort care" alternative with limited intervention (97%, 134/138), and options for pregnancy termination at different stages (91%, 126/138) should be included. Physicians that disagreed with the statement "some life is better than no life at all" were statistically more likely (p < 0.001) to report that prenatal counseling regarding "options for pregnancy termination services at different stages of pregnancy" was important. There was a statistically significant difference in the counseling provided to parents based on the physician's personal and professional views on palliative care and termination of pregnancy.

Conclusion: Physicians' self-reported beliefs impact the counseling content provided to families in the setting of a prenatal diagnosis of CCHD.