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J Perinatol. 2017 Nov;37(11):1224-1229. doi: 10.1038/jp.2017.118. Epub 2017 Jul 27.

Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors.

Author information

1
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Berman Institute of Bioethics, Baltimore, MD, USA.
3
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
4
Department of Palliative Care, Montefiore University Hospital, Pittsburgh, PA, USA.
5
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.

Abstract

OBJECTIVE:

Delivering prognostic information to families requires clinicians to forecast an infant's illness course and future. We lack robust empirical data about how prognosis is shared and how that affects clinician-family concordance regarding infant outcomes.

STUDY DESIGN:

Prospective audiorecording of neonatal intensive care unit family conferences, immediately followed by parent/clinician surveys. Existing qualitative analysis frameworks were applied.

RESULTS:

We analyzed 19 conferences. Most prognostic discussion targeted predicted infant functional needs, for example, medications or feeding. There was little discussion of how infant prognosis would affect infant/family quality of life. Prognostic framing was typically optimistic. Most parents left the conference believing their infant's prognosis to be more optimistic than did clinicians.

CONCLUSIONS:

Clinician approach to prognostic disclosure in these audiotaped family conferences tended to be broad and optimistic, without detail regarding implications of infant health for infant/family quality of life. Families and clinicians left these conversations with little consensus about infant prognosis.

PMID:
28749479
PMCID:
PMC5688012
DOI:
10.1038/jp.2017.118
[Indexed for MEDLINE]
Free PMC Article

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