Communicating Prognosis With Parents Of Critically Ill Infants: Direct Observation Of Clinician Behaviors

Communicating Prognosis With Parents Of Critically Ill Infants: Direct Observation Of Clinician Behaviors

Boss RD; Lemmon M E; Arnold RM; Donohue PK

DOI: 10.1038/jp.2017.118

Journal Of Perinatology : Official Journal Of The California Perinatal Association

2017

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.Journal of Perinatology advance online publication, 27 July 2017; doi:10.1038/jp.2017.118.

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