Order Effects of Prematurity Outcome Data
Condition: Premature Birth
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      Women recruited from the internet were put in a hypothetical situation of being in labor at
      22 weeks of pregnancy, and presented with information in the form of pictographs about
      survival and disability of babies born at this gestational age.

      Participants were randomized to receive these pictographs in a different order (survival or
      disability first) and to receive descriptiveness level of survival (just numerical
      information, or also description of course of NICU stay).

      Participants were then asked to choose between comfort care and intensive care in this
      situation. Participants' religiosity, value of the sanctity of life, and health literacy were
      also assessed.
    

Detailed description: 
      The National Institute of Child Health and Human Development (NICHD) Workshop on Periviable
      Birth recommended that information on the chance of survival and risk of disability should be
      provided separately. The order in which information is presented can affect memory,
      persuasiveness, and treatment choice, but the effect of order of information presentation in
      the context of neonatal resuscitation has received little attention. Additionally, the effect
      of including a description of the long and intense time in the neonatal intensive care unit
      (NICU) on parental treatment decision making is also unexplored. Current evidence suggests
      that pictographs best convey numerical information to parents.

      Three pictographs were developed based on NICHD data for 22 weeks gestational age (GA) babies
      who received intensive care. One pictograph displayed information on the rates of disability
      in the babies who survive. Two pictographs displayed information about how many babies born
      at 22 weeks survive, with one of these pictographs including a description of the average
      course of NICU stay.

      An internet survey was sent to a U.S. representative sample of women of child-bearing age. A
      vignette including background on prematurity and the treatment options of intensive care or
      comfort care for a baby born at 22 weeks GA was presented. Participants viewed the
      pictographs, evenly randomized to one of four experimental conditions (order of information
      presentation x level of description of NICU course). Participants were then asked to choose
      intensive care or comfort care. Participant religiosity, values (quality vs. sanctity of
      life), autonomy preferences in medical decision making, previous NICU exposure, numeracy, and
      health literacy were also assessed.
    

Intervention name(s): Order of pictographs provided to participants; Level of description in survival pictograph
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The pictographs presented to participants about survival and disability were varied in the order in which they were presented (i.e. survival or disability information first).; The pictographs presented to participants about survival and disability were varied in the level of description provided in the survival pictograph (i.e. only numerical data, or also a description of course of NICU stay).
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: 2x2 between subjects
Masking: Single (Participant)
Primary purpose: Other
Keywords: Decision making; Neonatal resuscitation; Order effect; Prenatal counseling