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BMJ. Jan 6, 2007; 334(7583): 1.
PMCID: PMC1764103

Communicating with parents on the neonatal unit

Peter W Fowlie, consultant paediatrician and Allan Jackson, specialist registrar in neonatal medicine

Should we be doing more than just talking?

Good communication underpins “good medical practice,”1 whereas poor communication results in patient dissatisfaction, increased complaints, and increased litigation.2 Surprisingly, therefore, other than in the field of cancer care3 there is a lack of literature to guide clinicians on how to improve communication. In this week's BMJ, a randomised controlled trial by Koh and colleagues investigates whether providing mothers of babies in neonatal intensive care units with audiotapes of their conversations with a neonatologist improves recall of information and psychological wellbeing.4

The concept of family centred care within the neonatal unit is based on the philosophy that “[care] … should be based on open and honest communication between parents and professionals.”5 Although few would disagree with this, many of the ethical and medical issues that are encountered routinely in the neonatal unit are highly complex and have to be communicated to parents who are under extreme pressure in a hostile environment.6 Effective communication is therefore a particular challenge in the neonatal unit.

The trial by Koh and colleagues found that mothers who received audiotapes of their consultation recalled significantly more information about diagnosis, treatment, and outcome than women in the control group at 10 days and at four months.

However, despite the encouraging results the trial has limitations. The primary outcome was recall of information up to four months, which is a relatively short follow-up period. Also, no significant differences were found for other outcomes such as patient satisfaction, parental anxiety and depression, or parental stress up to a year later. The interpretation and clinical importance attached to these findings may vary according to who is looking at the data—parent, neonatologist, neonatal nurse, family doctor, or healthcare provider.

Using audiotapes in clinical practice would raise important practical issues. Which conversations or discussions would be recorded and who would decide? Parents need to exchange information with medical and nursing staff,7 and it could be argued that using audiotapes might make the exchanges more formal.

Koh and colleagues used cassette tapes, which are becoming increasingly obsolete in today's technologically advanced society. More recent formats like compact discs and MP3 files may be more appropriate but are not yet universally used and need to be tested in this situation. Taped conversations may be regarded as part of the medical record, therefore a confidential archive would be required to store and retrieve the information. Data may need to be stored indefinitely for medicolegal reasons, which could be costly, although the use of electronic patient records might facilitate this. In developing countries where neonatal services have limited resources, introducing this sort of practice may not be seen as a priority.

Any communication strategy in whatever setting must be effective, practical, and affordable. While Koh and colleagues' study adds to our knowledge and understanding of communication between doctors, patients, and relatives, the intervention needs to be made practical before it can be implemented widely. Other methods of improving communication such as providing written information, as already advocated by some professional bodies,8 may be more practical and are worthy of assessment.

Notes

Competing interests: None declared.

References

1. UK General Medical Council. Good medical practice. London: GMC, 2006. www.gmc-uk.org/guidance/good_medical_practice/index.asp
2. Teutsch C. Patient-doctor communication. Med Clin North Am 2003;87:1115-45. [PubMed]
3. Back A. Patient-physician communication in oncology: what does the evidence show? Oncology Williston Park 2006;20:67-74. [PubMed]
4. Koh THHG, Butow PN, Coory M, Budge D, Collie L-A, Whitehall J, et al. Provision of taped conversations with neonatologists to mothers of babies in intensive care: randomised controlled trial. BMJ 2006 doi: 10.1136/bmj.39017.675648.BE [PMC free article] [PubMed]
5. Harrison H. The principles for family-centered neonatal care. Pediatrics 1993;92:643-50. [PubMed]
6. Walker CH. Neonatal intensive care and stress. Arch Dis Child 1982;57:85-8. [PMC free article] [PubMed]
7. Kowalski WJ, Leef KH, Mackley A, Spear ML, Paul DA. Communicating with parents of premature infants: who is the informant? J Perinatol 2006;26:44-8. [PubMed]
8. Royal College of Paediatrics and Child Health. Good medical practice in paediatrics and child health. London: RCPCH, 2002. www.rcpch.ac.uk/publications/recent_publications/GMP.pdf.

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