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015 Interprofessional SDM of perinatal period; create a prototype flowchart
  1. Naoko Arimori1,
  2. Eri Shishido2,
  3. Kyoko Asazawa3,
  4. Naoko Hayashi2,
  5. Maki Chiba4,
  6. Shigeko Horiuchi2
  1. 1Graduate School of Nursing Sciences, Niigata University, Niigata, Japan
  2. 2Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
  3. 3Division of Nursing, Tokyo Healthcare University, Tokyo, Japan
  4. 4Department of Nursing, Mukogawa Women’s University, Nishinomiya, Japan


Introduction Perinatal decision-making is challenging due to bioethical issues regarding surrogate decision-making for the fetus and neonate, consensus building among couples, treatment choices related to the fertility of pregnancies complicated by cancer, and timing constraints of pregnancy terminations. Multidisciplinary collaborations between obstetrics and pediatrics, gynecology and oncology is also necessary. We developed a prototype version of a flowchart on SDM for multidisciplinary collaboration in difficult perinatal decision-making. We compared and discussed the differences in flowchart development based on prenatal decision-making tasks.

Methods 1) Difficult situations in the perinatal period were selected as (i) choice of infertility treatment,young pregnancy, (iii) choice of treatment for breast cancer related to fertility, and (iv) choice regarding the care of critically ill fetuses and newborns. 2) The steering committee developed a multidisciplinary decision-making support flowchart as a common model for the four areas. 3) Decision aids and guidebooks/procedure manuals were also prepared when necessary. 4) The flowcharts for the four areas were reviewed by the steering committee.

Results (i) The flowchart was helpful for young pregnancies and addressed the problem on the lack of support on decision-making. (ii) The flowchart for infertility was created to support the choice on whether to end or improve treatment. (iii) The flowchart for choice of treatment for breast cancer related to fertility was developed based on the cooperation between the breast surgery outpatient clinic and the reproductive medicine outpatient clinic. (iv) The flowchart regarding the care for critically ill fetuses and newborns focused on decision-making on how to spend time with the child.

Discussion The flowchart common to the four areas was a progression from informed decision-making to SDM to IPSDM.

Conclusion SDM through multidisciplinary collaboration in the perinatal period has different flowcharts depending on the background of the client and the characteristics of the medical care.

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