This study evaluates parents’ and health care providers’ (HCPs) descriptions of hope following counseling of parents at risk of delivering an extremely premature infant. Data came from a longitudinal multiple case study investigation that examined the decision-making and support needs of 40 families and their providers. Semi-structured interviews were conducted before and after delivery. Divergent viewpoints of hope were found between parents and many HCPs and were subsequently coded using content analysis. Parents relied on hope as an emotional motivator, whereas most HCPs described parents’ notions of hope as out of touch with reality. Parents perceived that such divergent beliefs about the role of hope negatively shaped communicative interactions and reduced trust with some of their providers. A deeper understanding of how varying views of hope might shape communications will uncover future research questions and lead to theory-based interventions aimed at improving the process of discussing difficult news with parents.

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Objective To better understand preferred approaches that health care professionals could employ when caring for parents who are at risk for giving birth to an extremely premature infant. Methods Women who were at high risk of having a periviable birth were recruited from three tertiary care hospitals with Level 3 neonatal intensive care units. These women, as well as their partners, physicians, and nurses underwent structured interviews both before and after delivery. Interviews were analyzed for advice that was provided to health care professionals who could be involved in the future counseling of antenatal patients at high risk of periviable delivery. Results Forty women, 14 fathers, and 52 health care providers participated in the interview process. Two main themes were identified – namely, the fundamental importance of information provision and support. Nevertheless, although all participants agreed about the importance of these actions, several areas of discordance among participants were noted. Nearly one-third of parents emphasized the importance of “hope”; 60% and 45% recommended the provision of supplementary written and internet materials, respectively. In contrast, most health care providers expressed the importance of “objectivity,” and only 15% and 5% thought written or internet materials, respectively, were desirable, given the concern that supplementary information sources could be misleading. Conclusion Both patients and providers agree about the centrality of information provision and emotional support for women at risk for periviable delivery. This study not only elucidates preferred approaches and methods by which this information and support could be optimized, but also shows pitfalls that, if not avoided, may impair the relationship between provider and patient.

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