NEO-SPEAK: A conceptual framework that underpins breaking bad news in neonatology

Abstract

ObjectiveBreaking bad news in neonatology is a frequent and difficult challenge. Although there are guidelines for communicating with parents in pediatrics and neonatology, the specific framework for breaking bad news in neonatology has not been studied in more detail. Therefore, we aimed to identify determinants that are important for successful managing breaking bad news in neonatology from professionals' perspective and to develop a conceptual framework that underpins this challenging task.MethodsWe conducted seventeen semi-structured interviews with senior neonatologists of six perinatal centers of the highest level of care in Germany. The transcripts were analyzed according to Mayring's method of qualitative content analysis using inductive and deductive coding.ResultsEight determinants of breaking bad news in neonatology could be identified from the interviews. From these, we developed the conceptual framework NEO-SPEAK. The first three determinants, Neonatal prognostic uncertainty, Encounter in (triangular-)partnerships, Organization and teamwork (NEO) are directly related to the specific care situation in neonatology, whereas the others, Situational stress, Processuality, Emotional burden, Attention to individuality, Knowledge and experience, play a role for difficult conversations in general, but are subject to special modifications in neonatology (SPEAK). In addition, the results show that the context in neonatology as well as reciprocal effects on the team and the individual level of the physicians are important influencing factors in breaking bad news.ConclusionOn the one hand, the constitutional framework NEO-SPEAK shows which special aspects play a role in neonatology for the delivery of bad news, and on the other hand, it can help to identify and consider these aspects in clinical routine and training. Considering or reinforcing each NEO-SPEAK element when planning or delivering bad news may guide healthcare professionals through communication with parents of critically ill or premature newborns and support the resilience of the caring team.

Family Reflections on a Lifecourse Journey after Neonatal Intensive Care: Neurodiversity, Enablement and Hope

“…Most importantly, parents and families require compassionate care, honesty about the accuracy of precise predictions, and explicit messages that medicine will be there as a resource for health, developmental, and family support. In this era of far-from-adequate medical homes and community support, health professionals must create shared decision making with practical updates across systems of care [10][11][12][13][14][15][16][17], Health professionals need also to recognize that past practices of communicating "the bad news about disability" in a few short counseling sessions before discharge is not sufficient [18][19][20]. They benefit from both simulated experiences and broader literature including lived experiences about disability and shared decision making [11][12][13][14][15][16][17].…”

“…In this era of far-from-adequate medical homes and community support, health professionals must create shared decision making with practical updates across systems of care [10][11][12][13][14][15][16][17], Health professionals need also to recognize that past practices of communicating "the bad news about disability" in a few short counseling sessions before discharge is not sufficient [18][19][20]. They benefit from both simulated experiences and broader literature including lived experiences about disability and shared decision making [11][12][13][14][15][16][17]. Too often, health professionals fail to acknowledge that much past information about intellectual disability left families stigmatized and isolated, and often blamed parents for not accepting outdated information [21,22].…”

“…Some guidelines for communicating uncertainty in settings of disability to families are highlighted in Table 1. The framework for these principles is based on references [3,11,12,19,20,25,26] as well as the lived experience of the author.…”

“…The key is to communicate in a respectful and shared decision-making manner respecting a life of neurodiversity [11][12][13]. 9.…”

Does Educational Status Influence Parents’ Response to Bad News in the NICU?

“…In previous analyses we defined determinants influencing BBN in neonatology [33] and compared parental preferences with their actual BBN experiences [34] and found that BBN not only burdened the recipients but also the messengers. The majority of parental top preferences differed significantly in their implementation in the real-life interview, and a compassionate delivery of bad news correlated highest with a parent-rated quality of BBN conversation.…”