Candidate and environment: Dr. Placencia is an accomplished investigator in neonatal ethics. His long term goal is to become an independent investigator who uses empiric evidence to change, modify, or support the normative ethical standards. He has identified a mentor who pioneered this approach, the support of a premiere research institute and clinical environment, and designed a career development program to augment his research skills and expertise in ethics. With these critical components, he will be uniquely qualified to achieve his goals. Objective: Develop an ethical model for parental perinatal decision making about the care of high-risk infants, and develop a clinical model by which parental decision making may be improved. Study Design: SA 1: Develop an evidence based critical appraisal of the Best Interests Standard (BIS). SA 1.1: Survey parents of high risk infants to determine what information they want regarding the familial impact of providing long term care, how such information would have shaped their decision-making, and whether it would have been appropriate for them to consider these effects? SA 1.2: Defend an empirically and ethically justified critical appraisal of the BIS by incorporating data gathered in our previou surveys on the conceptualization of the BIS and in SA1.1. SA 2: Develop, assess, and disseminate a data-driven, ethically justified model for prenatal education of pregnant women and their partners on the consequences to the infant of premature delivery. SA 2.1: Create of a series of educational videos for pregnant women at 18-30 weeks gestation and their partners, describing the current stage of fetal development and what to expect if the fetus delivers premature. SA 2.2: Determine the efficacy of the video on parental knowledge via pre- and post- assessments. SA 2.3: Assess maternal satisfaction with educational impact via post intervention survey. SA 2.4: Assess impact on decision making regarding resuscitation or life sustaining therapy (LST) amongst patients who deliver prematurely at 22-26 weeks. SA 2.5: Assess physicians'satisfaction with educational impact for parents of infants born between 22-34 weeks and impact on decisions regarding resuscitation or LST for infants born at 22-26 weeks. Future RO1: SA 3: Adaption of our model of prenatal education for non-academic obstetric settings. Future RO1: SA 4: Expand the study of the video's impact on parental decision making. Future RO1: SA 5: Adaption of the model for parents of infants with known congenital anomalies.
Prenatal counseling for premature delivery is often done in a suboptimal setting due to the nature of the condition. This may result in poorly informed decisions and have negative consequences on the health of the infant and family. This project will produce a data-driven, ethically justified model to address shortcomings in prenatal counseling for premature delivery and allow for development and dissemination of a clinical education model to address those shortcomings.