Table 3.
Strategies to facilitate communication with expectant parents during a prenatal consultation (to reorder and adapt as needed)
| Consultation phases | Key points |
|---|---|
| To prepare for consultation | |
| Preparation and setting | Speak with the mother’s HCP, obtain all relevant information regarding maternal and fetal health |
| Ensure use of interpretive services by a professional translator, if required | |
| Create a comfortable environment | Make sure to talk with both parents, if feasible |
| Make sure the consult is not disturbed (e.g., turn pager to vibrate, close the door or curtains, let the nurse know) | |
| Sit down, shake hands (if appropriate) and introduce yourself first, slowly and clearly | |
| Demonstrate openness to communication with and involvement of parents | |
| Ask about participants (e.g., use names, including the infant’s name, if known, and if parents agree you can use it) | |
| Assess parental knowledge of prematurity issues, along with perspectives, concerns, expectations, needs and preferences | Ask what they know about prematurity |
| Make sure you understand and acknowledge their values, perspectives and concerns (e.g., cultural/social background, religious beliefs, family structure) | |
| Adjust ways of communicating information to respect their values and preferences | |
| Support their involvement in decision making with inclusive wording (e.g., ‘How can I support you?’; ‘We can make this decision together’) | |
| During consultation | |
| Ensure factors that are important to parents are discussed (e.g., Ask what is important to them) | Typically, parents want to know about likelihood of survival, risk of NDD (with related challenges and opportunities), what medical problems might be encountered, possible treatments, what a preterm baby looks like, what it is like to be in the NICU, what happens after birth, how to manage breastfeeding, and their own role in the NICU (with explanations) |
| Discuss different choices or options | Present parents with the choices they need to make, clearly and accurately Offer appropriate management options based on the clinical situation |
| Share weighted and balanced information | Include both positive and negative aspects of care, pros and cons of the options, treatable and untreatable conditions |
| Disclose potential outcomes according to parental preferences: | |
| • Use grading words (majority, most, significant, some, a minority) and numbers when possible (6 out of 10, rather than 60%) | |
| • Use a consistent denominator when presenting different options, outcomes or event rates, to make the information easier to understand, interpret or compare (XX out of 10, 100 or 1000). For example, saying ‘Out of 100 babies, 20 will die, 20 will survive with NDD, and 60 will survive with no NDD,’ is better than saying 20 out of 100 for one outcome, then 1 out of 5 for another.Disclose uncertainty (i.e., the limits of statistics when applied to a particular baby) | |
| Additional strategies to build trust | Allow parents to lead the conversation: |
| • Use their verbal, nonverbal cues to pace discussion | |
| • Ask how you can support them | |
| • Invite them to share how they see the situation | |
| • Use open-ended questions (‘How…?’, ‘Could you tell me more?’, ‘Can you describe…?’) | |
| • Always ask whether parents have questions or need clarification | |
| Listen for concerns and emotions, and be empathetic and supportive: | |
| • Validate the difficulty of their situation | |
| • Use a soft voice, allow silences, use appropriate touch | |
| • Acknowledge and be sensitive to emotional reactions and concerns | |
| • Support parental needs and values | |
| Answer questions and be sure parents have received and understand the information to the extent they want to | |
| Maintain eye contact with both parents | |
| Offer time to think and reflect | |
| Avoid interrupting. Be quiet as parents describe perspectives, values or preferences | |
| Note: Obtaining informed consent for a management plan requires—at a minimum—sharing accurate information tailored to the parents’ needs regarding the risk of death and NDD, and the opportunity of having a surviving child with or without NDD | |
| Show compassion and acknowledge parental distress | Reassure parents that they did not do anything to cause preterm birth |
| Confirm the uniqueness of their family and of the unborn baby | |
| Acknowledge their baby as a being, not a GA | |
| Provide value-neutral information (i.e., by including the positives of having an infant they can love and cherish) | |
| Be honest | |
| Concluding the consultation | |
| Provide support and give parents realistic hope | Validate their situation as very difficult and their reactions as understandable |
| Tell them that every hour, day and week that the pregnancy continues (with baby and mom in stable condition) has positive effects | |
| Make sure they know that they are not alone | |
| Make sure they understand that you are there to provide more information and answer new questions | |
| Invite them to write their questions down as they think of them, for next time | |
| Meet with parents the following day, if possible, or at any time after the initial consultation |
*Adapted with permission from ref. (89)
HCP Health care professional; NDD neurodevelopmental disability; NICUNeonatal intensive care unit