Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology

Abstract

BACKGROUND AND OBJECTIVES: Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. METHODS: Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. RESULTS: Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations .9 out of 10 and were all ranked top 10 communicators. CONCLUSIONS: During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication. * P , .05 ** P , .01. Dr Zao contributed to the acquisition of data, interpretation of data (behavior coding), and critically revised the article for important intellectual content; Dr Lachance contributed to the acquisition of data, interpretation of data (quantitative portion), and critically revised the article for important intellectual content; and all authors contributed to the conception and design of the study, ensure that questions relating to accuracy or integrity of any part of the work are appropriately investigated and resolved, agree to be accountable for all aspects of the work, and approved the final version of the article as submitted.

Improving Patient- and Family-Centered Communication in Pediatrics: A Review of Simulation-Based Learning

“…Although the majority were oriented toward single-discipline groups, there were several examples of studies using interprofessional health care professional teams that included physicians, nurses, social workers, chaplains, respiratory therapists, and occupational and physical therapists. 4,5,8,[22][23][24][25][26]…”

“…SBL-CS can take many forms, often focusing on one specific situational context in which to improve skills. For example, there were educational interventions focused solely on breaking bad news, 6,7,25,30,36,37,41 disclosing medical error, 42 discussing end-of-life and palliative care, 11,15,17,23,33,35,38,39,43 interviewing in a patient-centered manner, 9,44 and promoting cultural competency. 26,45 There were other educational curricula that simulated difficult conversations in more than one context and included multiple scenarios such as end-of-life care, medication error, child abuse, and vaccine hesitancy.…”

“…15 Learners included nursing students, professional nurses, residents, fellows, staff physicians, and in some cases an interdisciplinary team. 5,8,11,14,[23][24][25][26] In general, data aimed at assessing learners' self-perceptions of change in skill immediately postintervention were positive; however, studies regarding retention of skills were limited. There was insufficient data to assess the advantage of one format versus the other; however, repeated exposure should lead to improved retention and application of such skills.…”

“…Qualitative analysis was used in a handful of studies to explore learners' thoughts regarding the simulation-based intervention using narratives or openended questions. 17,21,23,26,28 Thematic analysis was the analytic method most commonly used. 23,26,28 To illustrate, one study was helpful in identifying learners' perceptions of the benefits of simulating difficult conversations.…”

Pädiatrie aktuell – Forschung kurz notiert

“…Die Kommunikation mit Eltern sterbender Neugeborener stellt für Ärztinnen und Ärzte eine besondere Herausforderung dar. Eine kanadische Studie untersuchte nun, wie solche Gespräche idealerweiseablaufensollen [6]. 31 Testpersonen stellten sich dafür zur Verfügung, von ihnen wurden Videos unter simulierter Reanimation mit letztlich Pulslosigkeit/ Versterben des Neugeborenen erstellt.…”