This is a decision you have to make: Using simulation to study prenatal counseling

Renee D. Boss, Pamela K. Donohue, Debra L. Roter, Susan M. Larson, Robert M. Arnold

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Introduction: Prenatal decision making during extremely preterm labor is challenging for parents and physicians. Ethical and logistical concerns have limited empirical descriptions of physician counseling behaviors in this setting and constricted opportunities for communication training. This pilot study examines how simulation might be used to engage neonatologists in reflecting on their usual prenatal counseling behaviors. Methods: Neonatology physicians counseled a couple (standardized patients) with the female patient having impending delivery at 23 3/7 weeks. Encounters were videotaped. Physicians completed postencounter surveys and debriefing interviews. Mixed-methods analysis explored the outcomes of clinical verisimilitude and counseling behaviors. Results: All 10 neonatology physicians found that the simulation was highly realistic and that their behaviors paralleled neonatologist self-report in other studies. Physicians contributed more than 80% of encounter dialogue and mostly focused on biomedical information related to the acute perinatal period. Physicians spent nearly a quarter of each encounter in building relationships and expressing empathy. Most physicians initiated discussion about quality versus quantity of life but infrequently elicited the parents' related goals and values. When medical factors and family preferences were held constant, physicians assumed variable responsibility for making decisions about resuscitation. Most physicians declined parent requests for treatment recommendations, although all of those physicians felt more than 75% certain about what should be done. Conclusions: Simulation can reproduce the decisional context of prenatal counseling for extremely premature labor. These results have implications for communication training in any setting where physicians and patients without established relationships must discuss acute diagnoses and make high-stakes medical decisions.

Original languageEnglish (US)
Pages (from-to)207-212
Number of pages6
JournalSimulation in Healthcare
Issue number4
StatePublished - Aug 2012


  • Counseling
  • Neonatal resuscitation
  • Patient-physician communication
  • Premature infants

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'This is a decision you have to make: Using simulation to study prenatal counseling'. Together they form a unique fingerprint.

Cite this