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The complexity of physicians’ understanding and management of prognostic uncertainty in neonatal hypoxic-ischemic encephalopathy

Journal of Perinatology volume 39, pages 278–285 (2019)Cite this article

Subjects

Abstract

Objective

Prognosis of Hypoxic-Ischemic Encephalopathy (HIE) remains challenging and uncertain. This paper investigates how physicians understand and address the ethical challenges of prognostic uncertainty in the case of neonatal HIE, contextualized within the social science literature.

Study design

Semi-structured interviews were conducted with 12 Canadian neurologists and neonatologists, addressing their perspectives and clinical experiences concerning neonatal HIE prognostication. Interviews were analyzed using thematic content analysis.

Results

Participants unanimously recognized uncertainty in their prognostication. They identified several sources contributing to uncertainty in HIE prognostication, including etiology and underlying pathophysiologic mechanisms, statistical limitations, variable clinical data, the dynamic process of neurodevelopment, or the impact of hypothermia treatment. Unlike in some other literature, some physicians in this study talked about ways to render uncertainty explicit rather than hide it.

Conclusion

Results from this study support the call for recognition of the ubiquitous uncertainty surrounding this act in medical education and training.

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Acknowledgements

We thank Emily Bell for her assistance in adjudicating coding disagreements, and the members of the Pragmatic Health Ethics Research Unit for providing feedback about this project and this manuscript.

Funding

This research was funded by the Kids Brain Health Network. Eric Racine is additionally funded by a career award from the Fonds de recherches du Québec-Santé (FRQ-S) and M. Ariel Cascio by the SSHRC Banting Postdoctoral Fellowship and an Angelo-Pizzagalli Fellowship from the IRCM.

Author information

Author notes

  1. These authors contributed equally: M. Ariel Cascio, Amaryllis Ferrand.

Authors and Affiliations

  1. University of Vermont Medical Center, University of Vermont, Burlington, 111 Colchester Avenue, Burlington, VT, 05401, USA

    Lisa Anne Rasmussen

  2. Institut de recherches cliniques de Montréal, 110 Pine Avenue West, Montreal, QC, H2W1R7, Canada

    Lisa Anne Rasmussen, M. Ariel Cascio, Amaryllis Ferrand & Eric Racine

  3. McGill University, 845 Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada

    Lisa Anne Rasmussen, M. Ariel Cascio, Michael Shevell & Eric Racine

  4. Université de Montréal, 2900, boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada

    Amaryllis Ferrand & Eric Racine

  5. McGill University Health Centre, 1001 Decarie Boulevard, B.RC. 6354, Montreal, QC, H4A 3J1, Canada

    Michael Shevell

Authors
  1. Lisa Anne Rasmussen
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Corresponding author

Correspondence to Eric Racine.

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The authors declare that they have no conflict of interest.

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Rasmussen, L.A., Cascio, M.A., Ferrand, A. et al. The complexity of physicians’ understanding and management of prognostic uncertainty in neonatal hypoxic-ischemic encephalopathy. J Perinatol 39, 278–285 (2019). https://doi.org/10.1038/s41372-018-0296-3

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