Breaking Bad News to a Pregnant Woman With a Fetal Abnormality on Ultrasound

Abstract

Ultrasound is a common procedure performed in pregnancy. Most obstetric patients have an ultrasound between 18 and 20 weeks' gestation. While there is debate regarding the utility of this ultrasound, it has become a routine part of prenatal care. Discovery of a fetal anomaly on ultrasound is most commonly an unexpected, emotionally devastating event for pregnant women. Counseling these women about the ultrasound findings requires empathy and sensitivity. This task falls on the physicians caring for pregnant women: maternal-fetal medicine specialists, radiologists, generalist obstetricians, and family medicine physicians. Their training regarding breaking bad news is varied. Therefore, the purpose of this article is to provide a framework to break bad news of an anomalous fetus for physicians caring for pregnant women using the SPIKES protocol. The SPIKES acronym stands for setting, perception, invitation, knowledge, empathize, summary, and strategy.

Experiences and outcomes following diagnosis of congenital foetal anomaly and medical termination of pregnancy: A phenomenological study

“…Emotional support and help relationships exist to assist in the communication of bad news related to foetal health, and these resources can humanise the approach taken to the medical interview (Asplin, Wessel, Marions, & Georgsson Ohman, ; Hafidz & Zaunidin, ). Nevertheless, the present study confirms prior research findings that medical personnel need to improve their communication skills and, above all, that the unpredictability that still characterises ultrasound screening for chromosomopathies and/or foetal malformations commonly makes it necessary to supply information abruptly and in a way that may seem improvised and insensitive (Greiner & Conklin, ). The clinical relationship between health professionals and their patients is generally shaped by the periodic tests and examinations performed to obtain prenatal diagnoses, and the success of this relationship largely depends on the physician's ability to interact with the patient and to engage in useful dialogue (Herrera et al, ).…”

Breaking bad news: A communication competency for ophthalmology training programs

“…2,4 This protocol has since been adapted to other areas of medicine, including obstetrics-gynecology, radiology, emergency medicine, and critical care. 14,15,26,32 SPIKES is now taught in many medical schools and has even been translated to other languages. 30, 36 …”

Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study

“…When a diagnosis of this type must be confirmed, the health carer often experiences anxiety, a feeling of responsibility and a fear of censure, while being pressured to supply a rapid, convincing explanation and at the same time respond to the patient's emotional reaction [8].…”

“…When a chromosome defect or severe foetal malformation is confirmed, the health team is obliged to inform the mother about the advisability of continuing the pregnancy, and of the prognosis and possible postpartum outcomes [7][8][9][10] respecting the patient's right to choose [4]. In many cases, healthcare personnel develop their own strategies, without taking into account the patient's holistic nature and without forming a comprehensive outlook on the health-disease binomial, capable of transforming information into a therapeutic tool [11].…”