Prenatal patient perceptions of receiving difficult news over the telephone

Abstract

Difficult news has been described as any news that adversely and seriously affects an individual's view of their future. Research in oncology genetic counseling demonstrated that individuals do not prefer in‐person or telephone delivery of their genetic test results. However, in the prenatal setting, there is limited research examining how patients prefer news related to their pregnancies be disclosed. This study aimed to assess the experiences and preferences of prenatal patients who received difficult news by telephone. A semi‐structured interview guide was developed to assess patients' personal definitions of difficult news and their experiences receiving the news by telephone. Fifteen patients seen prenatally by a genetic counselor were interviewed. Interviews were transcribed and consensus‐coded, using inductive content analysis to identify several themes. The most common definition of difficult news included unexpected, life‐changing, or devastating information. Participants described aspects of their experience and strategies employed by their genetic counselor that was helpful when receiving the news, which was found to align with the SPIKES protocol, a six‐step process of delivering difficult news to patients. Additional techniques that participants identified as beneficial and satisfactory included the genetic counselor's use of empathy, non‐directiveness, and continuity and coordination of care. Participants also provided recommendations for improvement, including a discussion of the mode of result disclosure during pretest counseling, an option to follow up with their genetic counselor, personalized resources, and a summary of the results call. The findings of this study demonstrate that a patient‐centered approach is preferred by patients who receive difficult news by telephone in the prenatal setting. Patients' identification of beneficial communication techniques and suggestions for improvement can be implemented by any healthcare provider responsible for delivering difficult news to prenatal patients.

Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals

“…Use of telemedicine has increased over the past few years following the COVID-19 pandemic [73]. Two studies provide guidance for HCPs conducting video consultations in prenatal setting [74,75 ▪▪ ]. An American study published in 2013 suggests that prepating patients with detailed information on what to expect from their virtual consultation ahead of the appointment may improve their experience.…”

“…A more recent study that interviewed 16 women who had received unexpected news by telephone has concluded that a patient-centred approach is most effective and beneficial for delivering difficult news to prenatal patients [75 ▪▪ ]. Signposting to written information, support group resources and follow-up care is deemed essential also in this setting [75 ▪▪ ]. Finally, feedback should be sought from the patients in order to improve this new type of service [74].…”

Telegenetics to provide comprehensive prenatal diagnosis

“…Patients' preference on the route of receiving difficult news varies based on the patient's understanding, support system, and personal values. 42 While further research is needed, shared decision-making continues to be central to patient care regardless of visit type. 42 Overall, telehealth is highly accepted but there continue to be limitations, such as, lack of appropriate funding for implementation, equipment, support services, and in the US insurance coverage and reimbursement barriers.…”

“…42 While further research is needed, shared decision-making continues to be central to patient care regardless of visit type. 42 Overall, telehealth is highly accepted but there continue to be limitations, such as, lack of appropriate funding for implementation, equipment, support services, and in the US insurance coverage and reimbursement barriers. 43 However, even in light of these barriers, a review of the literature indicates that the benefits far outweigh the limitations.…”

“…One understudied aspect of telegenetics in the prenatal setting is the disclosure of difficult news via video or phone. Patients' preference on the route of receiving difficult news varies based on the patient's understanding, support system, and personal values 42 . While further research is needed, shared decision‐making continues to be central to patient care regardless of visit type 42 …”