762 - Prenatal Consults with Spaced Repetition: A pilot randomized controlled trial studying the use of flash cards to aid prenatal consultations

Publication Number: 762.6242

Theodor Uzamere, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Nathan C. Sundgren, Baylor College of Medicine, Houston, TX, United States

Background: Neonatologists use prenatal consults to share information with parents expecting newborns needing intensive care. However, high anxiety, along with factors like maternal age, comorbidities, and limited English proficiency, can hinder comprehension. Visual aids used during consultations may help reduce anxiety and enhance recall, but they might not support ongoing learning after the consult ends. An alternative approach—spaced repetition—could allow parents to revisit information systematically over time.

Objective: Our team developed flashcards curated by both physicians and parents as an educational tool. This study aims to evaluate the impact of these flashcards on maternal anxiety and knowledge retention.

Design/Methods: Pregnant women admitted between gestations 25 0/7 and 34 6/7 weeks were eligible for this study. Participants were enrolled within 72 hours of the standard prenatal consult. Block randomization assigned participants to the Traditional Consult (TC) or the Spaced Repetition Consult (SRC). Patients were separated by gestation into three groups: 25 0/7 to 27 6/7, 28 0/7 to 31 6/7, and 32 0/7 to 34 6/7 weeks. Participants in the SRC cohort received a set of flashcards upon enrollment, along with specific instructions on which cards to review based on their baby’s gestational age and recommended review frequency. Each participant was followed at two additional visits: (1) after one week of NICU admission and (2) at discharge. Outcome measures were the PROMIS-Anxiety test and a 10-question multiple-choice knowledge test. Knowledge test questions were taken from a pool of questions that matched gestational age at time of consult. Changes from baseline in outcomes between the TC and SRC groups at subsequent visits were compared using a two-sample test.

Results: 65 women were enrolled. Six were lost to follow up (2 early neonatal death, 4 no response). This left 59 for analysis (Figure 1). Comparison of participant demographics and comprehension barriers did not yield any significant imbalances between randomized groups (Table 1). Changes in anxiety and knowledge scores did not differ significantly between the two groups and there was no significant difference when subjects were divided by gestation (Table 2).

Conclusion(s): Flashcards did not significantly affect anxiety levels or knowledge retention. However, parents shared positive feedback, appreciating the repository of personalized medical information for their child. This may suggest value in exploring the impact of flashcards on overall parent satisfaction with their NICU experience and education.

Flow Chart of RCT enrollment, randomization, and follow-up.
FinalFinalPASFlowChart.pdf

Baseline demographics and comprehension barriers at time of randomization.
PASTable1.pdfDemographics collected were age, race/ethnicity, education level, marital status. Comprehension barriers collected were whether in pain or alone during consult.

Anxiety and Knowledge Score changes from baseline compared between Traditional Consult and Spaced Repetition Consult.
PASFinalTable2.pdfParticipants’ changes in anxiety and knowledge scores from enrollment baseline were averaged and compared by intervention of traditional consult (TC, without the flashcards) to spaced repetition consults (SRC, with the flashcards). The data was further delineated by gestational age strata at time of enrollment. There was no significance between TC control and SRC intervention in any comparison. Data presented as mean ± S.D.