Use of a visual aid to improve counseling at the threshold of viability

Venkatakrishna Kakkilaya, Lynn J. Groome, Daci Platt, Dalibor Kurepa, Arun Pramanik, Gloria Caldito, Lesley Conrad, Joseph A. Bocchini, Terry C. Davis

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


OBJECTIVES: To pilot-test a visual aid developed to help counsel pregnant women. METHODS: After agreeing to participate, pregnant women at >28 weeks of gestation were assigned randomly to counseling with or without a visual aid. The visual aid contained pictures, graphics, and short messages about delivery room resuscitation, chances of survival, anticipated neonatal course, and long-term neurodevelopmental disabilities. A neonatal fellow performed counseling with a standardized script for an anticipated delivery at 23 weeks of gestation. In precounseling and postcounseling sessions, women were given a structured interview to assess their knowledge of chances of survival and disability and attitudes toward resuscitation. RESULTS: Of the 89 women who participated, 76% were black and 59% read below a 9th-grade level. Compared with the no-visual aid group, women in the visual aid group recalled more disabilities and predicted longer neonatal stays (P = .01). For both groups, mothers' perceptions of the chances of survival were lower after counseling; the decrease was greater in the visual aid group (P = .03). The majority of women in each group opted for resuscitation, which was not affected by counseling. In multivariate analyses, use of the visual aid was a significant independent factor in explaining before/after differences in survival chances and recall of a long NICU stay and number of disabilities; higher literacy levels also were significant for recalling the number of disabilities. CONCLUSIONS: Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.

Original languageEnglish (US)
Pages (from-to)e1511-e1519
Issue number6
StatePublished - Dec 2011


  • Decision aid
  • Extremely preterm
  • Health literacy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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