Sonographers’ communication in obstetrics: Challenges to their professional role and practice in Australia

Abstract

Introduction/Purpose: Despite the clinical importance of patient-centred care in the sonographer/patient interaction in obstetric ultrasound, there has been very little current research in Australia on sonographer and sonologist communication practices in the event of an adverse finding. This study sought the views, experiences and practices of Australian sonographers, particularly in relation to adverse findings, with consideration of the implications for their professional role and practice. Methods: Qualified and trainee sonographers who perform obstetric ultrasound were invited to complete a survey through the Australasian Sonographers Association. Using qualitative methodology, the authors developed themes on a range of issues related to sonographer and sonologist communication practices and roles from responses to three open-ended questions within the survey. Result: Analysis of 249 responses revealed three distinct 'Communicator types'. 'Open Communicators' confidently practice open and direct communication; 'Limited Communicators' perceived barriers preventing them from openly communicating; 'Variable Communicators' indicated various challenging 'grey areas' which created inconsistent communication practices. Variables, such as the complexity of an adverse finding and a reporting sonologist's role, attitude and level of control they exercised over sonographer communication, all influenced respondents' communication practices. Respondents believed professional bodies should agree on a standardised policy regarding sonographers' roles.Discussion: This paper highlights the complexity of the sonographer/patient interaction and outlines the difficulty in providing true patient-centred care in obstetric ultrasound. Conclusion: The need for a collaborative, patient-focussed policy, which defines and recognises the role of the sonographer in the event of obstetric adverse findings, will improve the current model of care.

Sonographers’ level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?

“…The 'Open Communicator' openly discusses results; the 'Variable Communicator' changes their practices depending on the circumstances, and the 'Limited Communicator' rarely communicates findings directly to obstetric patients. 9 These different styles reflected differences in sonographers' understanding of their role, sense of professional identity and how multiple factors influenced the autonomy they experienced in communicating results with pregnant patients. For anonymity, pseudonyms have been used.…”

“…Her professional identity in this model of care differs from Chloe and Val because she works for radiologists, not obstetricians. Restrictions and interprofessional boundaries like this can create a challenging and stressful workplace for sonographers, 2,9,36,37 leading to a loss of confidence, poor recognition and possibly a weakening of their professional identity. 38 Determining the roles of each team member in a multiprofessional context is vital to appreciate how each person contributes to patient care.…”

“…A full description of the research design and methodologies used in the overall project has been published elsewhere. 9 This paper consists of the qualitative findings describing sonographers' professional identity from the perspective of exercising a degree of autonomy in communicating with pregnant patients.…”

“…8 In Australia, the official report must be completed by a sonologist who is a physician specifically trained and qualified in ultrasound; in the case of obstetric examinations, it can be an obstetrician or radiologist. 9,10 According to the Royal Australian and New Zealand College of Radiologists (RANZCR), the role of the sonologist and sonographer is clearly defined:…”

“…15,16 In addition, the sonologist has the power to set protocols regarding communication practices between sonographers and patients, 17 however, these are highly variable and often ambiguous depending on the reporting sonologist and the practice setting. 9,18 This creates difficulties for Australian sonographers as frontline practitioners as they do not have any formal authority or control in their interactions with pregnant patients and other healthcare professionals, such as referrers. Our research suggests it is challenging for a sonographer to provide patient-focused care 9,18,19 and put the needs of the mother first when they are prohibited from discussing findings with a pregnant patient.…”