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dc.contributor.advisorKristin Mattocks, PhD MPHen_US
dc.contributor.authorDelaney, Kathryn
dc.date.accessioned2024-06-27T18:53:20Z
dc.date.available2024-06-27T18:53:20Z
dc.date.issued2024-06-25
dc.identifier.doi10.13028/rs25-6w79
dc.identifier.urihttp://hdl.handle.net/20.500.14038/53519
dc.description.abstractBackground: Periviability counseling involves engaging in difficult ethical decisions. The ethical frameworks used by patients and their healthcare providers to discuss this topic have not been previously studied. Objectives: This study assessed the ethical frameworks used by patients and by providers during periviability counseling and subsequent decision making. Study Design: This mixed methods study included patients between gestation ages 21 weeks 0 days through 24 weeks 6 days who required periviability counseling, and the providers performing this counseling. Counseling sessions between providers and patients were recorded, as were semi-structured follow-up interviews with patients. These recordings were transcribed and analyzed using thematic analysis. Demographic surveys were given to providers, and patient demographic, obstetric, and delivery information was abstracted from medical records. Results: A total of 11 patients and 11 providers participated in either a recorded counseling session, a follow-up interview, or both. Qualitative analysis revealed the following themes: 1) decisions regarding periviable intervention are the patient’s to make, 2) desire to avoid pain or suffering of the fetus/newborn, especially as it related to CPR, 3) doing what is best for the family, including partners and other children at home, 4) “doing everything” as a good in itself, and 5) periviable complications disrupt expectations about parenthood or pregnancy which then need to be reimagined. These themes corresponded to four distinct ethical frameworks: principlism, care ethics, virtue ethics, and narrative ethics. All of the patients, and approximately three-quarters of providers used at least one of these ethical frameworks; most used a combination of frameworks. Conclusions: Patients and providers engaging in decision making surrounding periviable intervention use commonly accepted ethical frameworks to discuss and decide how to proceed with these pregnancies.en_US
dc.publisherUMass Chan Medical Schoolen_US
dc.rightsCopyright © 2024 Kathryn Delaneyen_US
dc.rights.uriAll Rights Reserveden_US
dc.subjectObstetricsen_US
dc.subjectPeriviable Pregnancyen_US
dc.subjectPeriviabilityen_US
dc.subjectMedical Ethicsen_US
dc.subjectQualitative Studyen_US
dc.titleEthical Frameworks in Periviable Decision-Making: Patient Perspectives and Provider Patternsen_US
dc.typeMaster's Thesisen_US
refterms.dateFOA2024-06-27T18:53:21Z
dc.contributor.departmentObstetrics and Gynecologyen_US
dc.description.thesisprogramMaster of Science in Clinical Investigationen_US
dc.identifier.orcid0000-0002-4666-6065en_US


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