Mother–Clinician Miscommunication Common in Neonatal ICU

Steven Fox

August 16, 2012

August 16, 2012 — Mothers of critically ill infants and the clinicians caring for those neonates may think they are communicating with one another clearly, but that may not be the case, according to results from a survey-based study of 101 mother–clinician pairs carried out in a university-based neonatal intensive care unit (NICU). The disconnect was particularly apparent in discussions regarding the severity of the children's illness, the researchers report online August 16 in the Journal of Perinatology.

"Given the complexity of the medical information in the NICU, the parents' emotional distress, and often the mother's own medical concerns, communication can be difficult," lead investigator Stephanie de Wit, MD, from the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, and colleagues write.

Yet clinicians need to ensure parents are aware of pertinent medical information so they can help make informed decisions regarding their children's' care, the authors note.

That means clinicians face the formidable challenge of conveying timely information to parents and tailoring their explanations as needed to make sure the information is understood.

However, little research has been done to assess how well clinicians do when it comes to discerning whether parents understand the information being conveyed.

To find out more, Dr. de Wit and colleagues designed a prospective survey-based study of mother–clinician communication in the NICU at Johns Hopkins University Hospital.

"Our goal was to explore maternal and clinician perceptions of the quality of their discussions, to assess maternal understanding of their infant's medical condition as a result of those discussions and to gauge clinician estimates of maternal understanding," the authors write.

Between May 2010 and February 2011, the researchers surveyed 101 English-speaking mothers and the clinicians who were treating their infants. The investigators asked study participants about the quality of their communications and their understanding of the infants' clinical situation. A wide range of clinicians were included in the survey: physicians, neonatal nurse practitioners, nurses, and respiratory therapists.

The infants were in the NICU for a variety of reasons: 17% had very low birth weight, 36% had received mechanical ventilation, and 19% required surgery. After leaving the NICU, 44% went to other facilities for additional care. Two of the infants died while in the NICU.

The results of the mother–clinician survey showed that even when mothers and their clinicians agreed their communications had gone well, misunderstandings were common. Specifically, 89% of mothers and 92% of the clinicians said their discussions had been productive. All the mothers could identify at least 1 of their infants' diagnoses, and nearly all (93.4%) could identify at least 1 of the interventions being used to treat their infants.

However, only 45% of mother–clinician pairings agreed on the severity of the infants' illness. When such discrepancies in perception did exist, nearly two thirds of the time (62.5%), mothers believed their infants were less ill than the clinicians did.

"A common framework of an infant's illness, including severity and prognosis, should serve as a foundation for such discussions, yet our results and those of others imply mothers and clinicians may be entering these conversations with differing opinions regarding an infant's status," the authors write.

The authors suggest several ways for clinicians to improve communication, including:

  • Initiate frequent discussions with parents to update them on their infant's condition and any additional interventions that may be needed.

  • Avoid confusing medical terminology as much as possible.

  • Be honest and frank about the infant's condition and prognosis.

  • Ask follow-up questions to ensure parents understand what is being discussed.

The authors have disclosed no financial conflicts of interest related to this study.

J Perinatol. Published online August 16, 2012.

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