Factors that Influence the Communication of Adverse Findings in Obstetrics: A Survey of Current Sonographer Practices in Australia

Abstract

Objective: To identify factors influencing sonographers’ practices in communicating adverse obstetric findings and to understand their views on the need for standardized national policies and guidelines. Methods: Qualified and trainee sonographers who currently perform obstetric sonography were invited to complete a survey through the Australasian Sonographers Association. Closed-ended questions sought information on the demographic profile of the participants and their experiences on a range of issues related to workplace practices and policies. Open-ended questions allowed respondents to elaborate on workplace interactions and their views on the communication roles of sonologists (radiologists and obstetricians) and sonographers. Results: The practice setting, the background of the sonologist, the type of adverse finding, and the trimester in which a patient is scanned have an impact on the level of difficulty for sonographers in obstetric communication. These findings highlight a lack of uniformity of sonographer and sonologist communication with patients due to limited training, lack of formalized departmental policies, inadequate support, and communication practices by radiologists. As a result, respondents strongly supported the development of a standardized national policy. Conclusion: In the current environment of patient-centered care, sonographers are in a challenging position as they do not have policies supporting them as independent health care professionals, autonomously deciding on the best approach to communicate findings with their patients. This may lead to anxiety and stress if they lack control over the interaction. More support from sonologists in a radiology setting is needed. These findings should encourage professional bodies to address these issues by working collaboratively and to recognize the importance of the sonographers’ role and their unique position with pregnant patients.

Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery

“…14 In addition to these qualitative studies, there have been a small number of recent quantitative survey studies in sonographers. 15,16,17 Consistent with findings from studies in expectant parents, these have suggested that sonographers believe a policy of immediate disclosure of findings is a feature of patient-centred care, 8,17 but that delivering news in this way is challenging when guidelines are unclear or support from other healthcare professionals is lacking. 15,16 There is a need for further qualitative research to better understand the experiences of UK sonographers in relation to news delivery for three main reasons.…”

The challenges for patients and sonographers when complex obstetric anomalies are identified

“…Within Australia, the responsibility of the communication of unexpected findings in obstetric ultrasound has increasingly, yet inconsistently, shifted to sonographers 21 . A survey of qualified obstetric sonographers and trainees found that 79 (31.7%) respondents had communicated a congenital anomaly finding to their pregnant patient within the preceding month 22 . Despite this frequency, 63.5% of workplaces did not have policies about the communication of unexpected findings, and only 35% of the respondents had undertaken specific training, most commonly after qualifying 22 …”

“…21 A survey of qualified obstetric sonographers and trainees found that 79 (31.7%) respondents had communicated a congenital anomaly finding to their pregnant patient within the preceding month. 22 Despite this frequency, 63.5% of workplaces did not have policies about the communication of unexpected findings, and only 35% of the respondents had undertaken specific training, most commonly after qualifying. 22 Expectant parents are often alluded to unexpected findings through the sonographers' body language and they have expressed a desire for immediate information.…”

“…22 Despite this frequency, 63.5% of workplaces did not have policies about the communication of unexpected findings, and only 35% of the respondents had undertaken specific training, most commonly after qualifying. 22 Expectant parents are often alluded to unexpected findings through the sonographers' body language and they have expressed a desire for immediate information. 19,20 Delays in the communication of results can prompt feelings of anger and hurt and can cause distrust in providers.…”

Sonographers’ level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?

“…9,18 This creates difficulties for Australian sonographers as frontline practitioners as they do not have any formal authority or control in their interactions with pregnant patients and other healthcare professionals, such as referrers. Our research suggests it is challenging for a sonographer to provide patient-focused care 9,18,19 and put the needs of the mother first when they are prohibited from discussing findings with a pregnant patient.…”