Mitchell, TK;
Popa, M;
Ashcroft, RE;
Prasad, S;
Sharp, A;
Carnforth, C;
Turner, M;
Khalil, A;
Fenwick, N;
Leven, S;
et al.
Mitchell, TK; Popa, M; Ashcroft, RE; Prasad, S; Sharp, A; Carnforth, C; Turner, M; Khalil, A; Fenwick, N; Leven, S; FERN study team; Woolfall, K
(2024)
Balancing key stakeholder priorities and ethical principles to design a trial comparing intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy: FERN qualitative study.
BMJ Open, 14 (8).
e080488.
ISSN 2044-6055
https://doi.org/10.1136/bmjopen-2023-080488
SGUL Authors: Khalil, Asma
Abstract
OBJECTIVES: As part of the FERN feasibility study, this qualitative research aimed to explore parents' and clinicians' views on the acceptability, feasibility and design of a randomised controlled trial (RCT) of active intervention versus expectant management in monochorionic (MC) diamniotic twin pregnancies with early-onset (prior to 24 weeks) selective fetal growth restriction (sFGR). Interventions could include laser treatment or selective termination which could lead to the death or serious disability of one or both twins. DESIGN: Qualitative semi-structured interviews with parents and clinicians. Data were analysed using reflexive thematic analysis and considered against the Principles of Biomedical Ethics. PARTICIPANTS AND SETTING: We interviewed 19 UK parents experiencing (six mothers, two partners) or had recently experienced (eight mothers, three partners) early-onset sFGR in MC twin pregnancy and 14 specialist clinicians from the UK and Europe. RESULTS: Participants viewed the proposed RCT as 'ethically murky' because they believed that the management of sFGR in MC twin pregnancy should be individualised according to the type and severity of sFGR. Clinicians prioritised the gestational age, size, decrease in growth velocity, access to the placental vessels and acceptability of intervention for parents. Discussions and decision-making about selective termination appeared to cause long-term harm (maleficence). The most important outcome for parents and clinicians was 'live birth'. For clinicians, this was the live birth of at least one twin. For parents, this meant the live birth of both twins, even if this meant that their babies had neurodevelopmental impairment or disabilities. CONCLUSIONS: All three pregnancy management approaches for sFGR in MC twin pregnancy carry risks and benefits, and the ultimate goal for parents is to receive individualised care to achieve the best possible outcome for both twins. An RCT was not acceptable to parents or clinicians or seen as ethically appropriate. Alternative study designs should be considered to answer this important research question.
Item Type: |
Article
|
Additional Information: |
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
Keywords: |
fetal medicine, medical ethics, obstetrics, prenatal diagnosis, qualitative research, surgery, Humans, Female, Pregnancy, Pregnancy, Twin, Fetal Growth Retardation, Qualitative Research, Adult, Randomized Controlled Trials as Topic, Parents, Feasibility Studies, Male, Research Design, Interviews as Topic, United Kingdom, Watchful Waiting, Gestational Age, FERN study team, Humans, Fetal Growth Retardation, Feasibility Studies, Parents, Gestational Age, Pregnancy, Qualitative Research, Research Design, Adult, Female, Male, Interviews as Topic, Randomized Controlled Trials as Topic, Watchful Waiting, Pregnancy, Twin, United Kingdom, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences |
Journal or Publication Title: |
BMJ Open |
ISSN: |
2044-6055 |
Language: |
eng |
Dates: |
Date | Event |
---|
9 August 2024 | Published | 16 July 2024 | Accepted |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
|
PubMed ID: |
39122401 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/116744 |
Publisher's version: |
https://doi.org/10.1136/bmjopen-2023-080488 |
Statistics
Item downloaded times since 15 Aug 2024.
Actions (login required)
![Edit Item](/style/images/action_view.png) |
Edit Item |