The TOTAL trial dilemma: A survey among professionals on equipoise regarding fetal therapy for severe congenital diaphragmatic hernia.
Attitude of Health Personnel
Clinical Competence
Female
Fetal Therapies
Fetoscopy
Health Services Accessibility
Hernias, Diaphragmatic, Congenital
/ surgery
Humans
Male
Patient Preference
Perinatology
Practice Patterns, Physicians'
Randomized Controlled Trials as Topic
Referral and Consultation
Severity of Illness Index
Surveys and Questionnaires
Therapeutic Equipoise
Trachea
/ surgery
Journal
Prenatal diagnosis
ISSN: 1097-0223
Titre abrégé: Prenat Diagn
Pays: England
ID NLM: 8106540
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
10
07
2020
revised:
12
10
2020
accepted:
15
10
2020
pubmed:
20
10
2020
medline:
4
1
2022
entrez:
19
10
2020
Statut:
ppublish
Résumé
Running randomized clinical trials (RCT) in fetal therapy is challenging. This is no different for fetoscopic endoluminal tracheal occlusion (FETO) for severe left-sided Congenital Diaphragmatic Hernia (CDH). We assessed the knowledge, attitude and practice (KAP) of maternal-fetal medicine specialists toward the antenatal management of CDH, and the randomized controlled clinical (RCT) "Tracheal Occlusion To Accelerate Lung growth-trial." A cross-sectional KAP-survey was conducted among 311 registrants of the 18th World Congress in Fetal Medicine. The overall knowledge of CDH and FETO was high. Remarkably only 45% considers prenatal prediction of neonatal outcome reliable. Despite, in their clinical practice they perform severity assessment (80%) and refer families for FETO either within the context of an RCT (43%) or on patient request (32%). Seventy percent perceives not offering FETO on patient demand seems as if no treatment is provided to a fetus with predicted poor outcome. Only 20% of respondents considers denying access to FETO on patient demand not as a psychological burden. Often the views of individual respondents contradicted with their clinical practice. It seems that, for severe CDH, clinicians face personal and practical dilemmas that undermine equipoise. To us, this indicates the tension between the clinical and scientific obligations physicians experience.
Identifiants
pubmed: 33074552
doi: 10.1002/pd.5849
pmc: PMC7613473
mid: EMS152875
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
179-189Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 101957
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
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