O1112: Association of Socioeconomic Variables with Patient Empowerment in Pregnancies Complicated by Fetal Surgical Anomalies

Background: Patient empowerment has been described as an important patient-centered metric quantifying the ability of patients to gain control over decisions and actions directly affecting their health. For women with pregnancies complicated by surgical fetal anomalies (P-SFA), empowerment is an essential component of prenatal counseling and shared-decision making. Empowerment in uncomplicated pregnancies has been associated with improved outcomes including promotion of recommended health services during pregnancy and delivery to prevent prematurity and improve overall neonatal survival. However, there is little research regarding the affect of socioeconomic variables on empowerment in P-SFA.

Methods: A cross-sectional survey study was conducted from 5/2021–5/2022 to assess empowerment in women with P-SFA. Validated surveys administered included the Pregnancy Related Empowerment Scale (PRES) and Patient Empowerment Scale (PES) (scores range from 16–64). PRES quantifies empowerment related to self-care during pregnancy. PES quantifies empowerment related to future care of an unborn child. Socioeconomic variables included age, ethnicity, primary language, education, employment, health insurance status, and household income. Survey results are reported as mean with standard deviation (SD). Two-sample t-test was used to compare survey scores across socioeconomic groups.

Results: Seventy-four patients were recruited for participation.The mean age and gestational age at recruitment was 30 years (SD 6) and 27 weeks (SD 4), respectively. A majority of mothers were older than 25 years of age (n=52, 70%). Mothers more commonly preferred English as primary language (n=61, 82%) and were non-Hispanic (n=43, 58%). Thirty-five percent (n=26) of mothers were out of state referrals. A majority of mothers had a college or advanced degree (n=38, 51%). Half of the mothers were employed at the time of referral (n=36, 49%) with private health insurance (n=38, 51%) and a household income >$50,000 (n=38, 51%). The most common surgical diagnoses were neural tube defect (n=23, 31%), congenital lung malformation (n=17, 23%), and congenital diaphragmatic hernia (n=10, 14%). Lower PRES scores were observed in Hispanic mothers and mothers who preferred Spanish as primary language (Table). Mothers less than 25 years old and those who identified as Hispanic had lower PES scores (Table). There was no difference in scores for other socioeconomic variables or specific fetal diagnoses.

Conclusion: Younger women, Hispanic women, and Spanish speaking women with P-SFA have decreased empowerment scores. These findings suggest a need for development of culturally competent, targeted interventions to improve patient empowerment with the potential for subsequent improvements in patient health and patient centered outcomes in this high risk population.