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• W2116797654 abstract "29 March 2001 Dear Editor A SIMPLIFIED APPROACH TO IMPROVE SKILLS OF COMMUNICATION WITH PARENTS OF NEONATES UNDER INTENSIVE CARE: A PERSONAL VIEWPOINT The need for improving the skills of communication with parents can not be overemphasised given the improving survival of high-risk neonates and the increased prospects of ethical and medicolegal dilemmas. These extremely complex discussions regarding critical illness, prolongation of life, or withdrawal of life support need to be open and honest, with admission of uncertainty being needed in order to promote much needed trust in the relationship between doctors and patients. The broad spectrum of issues involved in the day to day discussions with parents of critically ill neonates and the level of expertise of the medical personnel involved including social and cultural influences often complicate these discussions and decisions. Needless to say a simplified approach to improving the skills of communication with parents is necessary especially for junior trainees as they often face these ethically and medicolegally complex issues directly. We wish to share our approach to training registrars in this vital aspect of neonatal intensive care. General principles: 1. Confirm the identity of the baby and the problem. 2. Check beforehand whether the parents are comfortable with the meeting place and the participants. 3. Greet the parents with an appropriate emotional response, address the baby by name and use the correct gender. 4. Begin with the positive aspects involving the baby’s clinical course briefly before the main problem is disclosed. 5. Disclose the main reason for the meeting and the level of your professional anxiety or worry. Specific points: 1. Use simple, preferably non-medical words and if needed simple diagrams to explain the nature of the problem, the time it was suspected or diagnosed, and specify whether: (a) the diagnosis is final or provisional (? more investigations, ? type, ? available locally); (b) the problem is life threatening, potentially debilitating or minor; (c) the problem is treatable or not. If treatable: does the treatment involve any side-effects, pain or discomfort?; how long would the treatment last ?; how would we know whether the treatment is working or not?; what will happen if we don’t treat the problem ?; and do we have time to think about the treatment options ?. (d) If the problem is not treatable, could we minimise any associated pain or discomfort? 2. Are there any common as well as rare differential diagnoses? 3. Summarise the nature of the problem, treatment options, and anticipated outcome(s) including recurrence. 4. Give the parents time to absorb the information. Listen to their thoughts and answer their questions. 5. Reassure the parents that you or other team members (preferably by name) are always available to answer any more questions that they may have at anytime. Choose timing for a repeat discussion or the next round of discussion depending on the nature or severity of the problem, and for availability of close family members who may have missed the first discussion. 6. If possible and if appropriate, explain briefly the division/ nature of the manpower in the nursery, with reassurance that at any given time there are at least two staff members directly involved in the care of their baby, and the consultant on call is always available to talk to them. Always document the details of the discussions for the use of other team members and also from the medicolegal point of view. 7. During day to day discussions it is important to avoid providing the family with a litany of results such as electrolytes and blood gases when all they wish to know is how the baby is doing in the most general terms.1 There is a thin line between including the family as a part of the decision making team and being overly dictatorial in management of their baby.1 In summary the simplicity and universal applicability of our approach in sharing information about any issues in neonatal intensive care (e.g. from extravasation injury, hypoglycemia, intraventricular hemorrhage to refractory respiratory failure) may help in improving the skills of communication with the parents. However, prospective assessment of such training is required.2" @default.
• W2116797654 created "2016-06-24" @default.
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• W2116797654 date "2001-08-31" @default.
• W2116797654 modified "2023-09-27" @default.
• W2116797654 title "A Simplified Approach To Improve Skills Of Communication With Parents Of Neonates Under Intensive Care: A Personal Viewpoint" @default.
• W2116797654 cites W2062614836 @default.
• W2116797654 doi "https://doi.org/10.1046/j.1440-1754.2001.0720d.x" @default.
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