Counseling parents of premature neonates on neuroimaging findings

Bernstein, Sarah; Canfora, Madison; Lemmon, Monica E.

doi:10.1016/j.semperi.2021.151474

Cited by 6 publications

(11 citation statements)

References 59 publications

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“…This study had several limitations. It is likely that the course and outcome of their own child, as well as parents’ personal characteristics or emotions, may have influenced participants’ responses . Enrollment was lower than expected, and generalizability is limited by the single-center design and underrepresentation of parents groups whose preference may differ (parents with mental health concerns, bereaved parents, parents from racial and ethnic minority groups) .…”

Section: Discussionmentioning

confidence: 95%

“…They are highly susceptible to postnatal complications such as intraventricular hemorrhage (IVH), which increases their risk of mortality and is a major cause of morbidity . Despite improved diagnostic capabilities and the increasing availability of long-term data on the outcome of very preterm infants, it remains a complex task for neonatologists to derive predictions for the short-term survival and long-term neurodevelopmental outcome of an individual infant from the results of general population-based research and to communicate these to parents . Moreover, physicians and parents are known to have different perspectives on the importance, discussion, and understanding of outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, physicians and parents are known to have different perspectives on the importance, discussion, and understanding of outcomes . Parents want and need prognostic information and communication tailored to their preferences . These are a prerequisite for developing realistic expectations for their child, adjusting to their role as parents, and participating in shared decision-making (SDM) as surrogates for their child .…”

Section: Introductionmentioning

confidence: 99%

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Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Forth,

Hammerle,

König

et al. 2024

JAMA Netw Open

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ImportanceIn the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.ObjectiveTo examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.Design, Setting, and ParticipantsThis crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.InterventionsAlternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).Main Outcomes and MeasuresThe primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.ResultsOf 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P &lt; .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, −0.34; −1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, −0.55; 95% CI, −1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P &lt; .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).Conclusions and RelevanceWhen given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.Trial RegistrationGerman Clinical Trials Register (DRKS): DRKS00024466

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Forth,

Hammerle,

König

et al. 2024

JAMA Netw Open

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“…20 Because nuanced discussions of developmental outcomes are commonplace in the NICU, there is likely a need for improved communication surrounding this subject. [21][22][23] While teaching participants how to use VALUES to learn about parent wishes and values, we identified that NICU clinicians may struggle to think about how to guide parents in thinking about activities for their seriously ill infants. We encouraged participants to consider holding the baby, participating in a religious ritual, or introducing the baby to family members as activities.…”

Section: Discussionmentioning

confidence: 99%

“…20 Because nuanced discussions of developmental outcomes are commonplace in the NICU, there is likely a need for improved communication surrounding this subject. 21–23…”

Section: Discussionmentioning

confidence: 99%

NeoTalk: Communication Skills Training for Neonatal Clinicians

Guttmann,

Meshkati,

Frydman

et al. 2023

Am J Hosp Palliat Care

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Background Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after “NeoTalk” and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses. Methods We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course. Wilcoxon signed rank tests and Kruskal-Wallis tests were performed to compare participant responses across time points. Results 34 providers completed NeoTalk training. Complete pre- and post-course data was available for 29 participants. Participants reported increased comfort with skills including ‘sharing difficult news’ ( P = .018), and ‘responding to emotion’ ( P = .002). Participants did not report increased frequency in using target skills 2 months after training. Conclusions A multi-disciplinary cohort of NICU providers endorsed increased confidence in key communication skills but not increased skill application 2-months post-course completion. While a single course can successfully teach skills, additional exposure may be necessary to build new communication habits. Our experience developing NeoTalk helped elucidate some of the ways in which conversations about seriously ill infants may be different from conversations about seriously ill adults.

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Pediatric Perspectives on Palliative Care in the Neurocritical Care Unit

Vermilion,

Boss

2024

Neurocrit Care

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Counseling parents of premature neonates on neuroimaging findings

Cited by 6 publications

References 59 publications

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants

NeoTalk: Communication Skills Training for Neonatal Clinicians

Pediatric Perspectives on Palliative Care in the Neurocritical Care Unit

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