Improving the communication of unexpected news in pregnancy ultrasounds
By Dr Judith Johnson
Not all pregnancies follow the textbook. Miscarriage or stillbirth occurs in 1 in 5, and in 1 in 20 an anomaly is found which could signal the presence of a health condition. Pregnancy complications are extremely distressing for expectant parents and increase women’s risk of experiencing depression, anxiety and trauma.
Ultrasound is a key tool for diagnosing a wide range of pregnancy complications and many parents clearly recall the moment that the sonographer tells them the first news of an unexpected finding. This moment often represents a turning point - the first step in a journey involving a period of shock, the need to make decisions and to eventually adjust to a new, unexpected situation with their pregnancy. The language used during scans is important to expectant parents, as it can have a powerful emotional impact. It can influence how they respond to the news, and any decisions they then make regarding how to move forward.
This moment of news delivery is important to sonographers too. Conducting obstetric ultrasounds is a demanding job and sonographers have unusually high rates of burnout. News delivery is a particularly challenging task, as sonographers have to communicate this to expectant parents with no time to prepare: expectant parents watch their face as they conduct the scan, and they have to share what they have found in real time. To add to this, they may have to deliver unexpected news multiple times within a day, but they receive no mandatory training for this task. Indeed, until now, sonographers have been expected to undertake this task without even having detailed guidance regarding the words and phrases they should use in these situations.
Our current article aimed to address this issue by developing consensus guidelines for the words and phrases sonographers should use in different news delivery scenarios. The first goal of our work was to improve the experiences of expectant parents by improving the language used to deliver news and by increasing sonographers’ confidence in this task. The second goal was to reduce sonographers’ stress and burnout by providing them with more support for this aspect of their work.
In order to create the guidelines, a wide range of charities, international academics, healthcare professionals and policy experts came together for a day-long workshop where areas of contention were discussed and agreement was reached. The guidelines were then drafted and circulated to all stakeholders for checking. Following two revisions, consensus was reached among all stakeholders.
In creating these guidelines, we wanted to move beyond previous recommendations for news delivery which are 1) usually focused on advising doctors and 2) tend to focus on general principles, rather than exact words. The situation for sonographers is different to most doctors: they have very little time to consider the exact words they should use and they cannot communicate in principles. We knew that it was going to be important to be specific. As such, the guidelines provide recommendations for the specific words and phrases which sonographers can use. Broader recommendations from the guidelines include:
The prioritisation of honest and clear communication, even with uncertain findings.
The use of technical terms. These should be written down for parents, together with non-technical interpretations.
The term ‘baby’ should be used as a default, even in early pregnancy, unless expectant parents use other terminology such as ‘foetus’.
At the initial news disclosure, communication should focus on providing information
Expectant parents should not be asked to make decisions during the scan
These guidelines are now used by the British Medical Ultrasound Society and will be used by several organisations that provide training to sonographers. We anticipate that they will be incorporated into the training provided to student sonographers. It is exciting to know that they might soon begin to influence practice. However, we know that there is more work to be done. In the UK, we are now working towards the development and testing of an intervention to train sonographers in news delivery which draws on these guidelines. To date, no research project has evaluated such a training intervention in this group. Internationally, we know that no other country has guidelines similar to ours. We hope that we will be able to support researchers and practitioners in these countries to develop similar recommendations designed for their own healthcare settings.
Article details
UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework
Judith Johnson, Jane Arezina, Liz Tomlin
First Published August 4, 2020 Research Article
DOI: 10.1177/1742271X20935911
Ultrasound
References
Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences by Judith Johnson, Alice Dunning, Raabia Sattar, Jane Arezina, Eve C. Karkowsky, Samantha Thomas, and Maria Panagioti
Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful? by Judith Johnson, Jane Arezina, Alison McGuinness, Anne-Marie Culpan, and Louise Hall
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