New Guidance on the Communication of Unexpected News

5th Aug 2020

Delivering unexpected news in obstetric ultrasound is challenging for healthcare professionals and can be a distressing experience for expectant parents. News delivery practices in obstetric settings vary internationally and the UK is one of few countries where sonographers deliver information about unexpected findings as standard. In other countries such as the US and Australia, policies differ according to the healthcare discipline of the ultrasound practitioner, their relationship with the referring clinician and the type of complication which has been identified.

Studies suggest that a policy of immediate disclosure is consistent with patient preferences, but that this practice can be stressful for healthcare professionals because, due to the immediate nature of the findings, they have no time to prepare before communicating with expectant parents. This situation is not acknowledged in current news delivery frameworks, which are based in oncology settings and presume that clinicians will have time to plan news disclosures before meeting with patients. Furthermore, in obstetric ultrasound settings, unexpected findings may be uncertain and professionals may be working under restrictive time constraints It is perhaps unsurprising, then, that expectant parents continue to report negative experiences of care at this time, such as delays in news delivery and the use of insensitive language by staff.

In the UK, there is no mandatory or standardised pre-qualification training for sonographers and ultrasound practitioners in communication. Most trainees receive some teaching on this topic as part of their course and describe learning skills for unexpected news delivery whilst on placement. Post-qualifying, a majority of sonographers seek continued professional development training in this area. However, one unresolved challenge for sonographers and ultrasound practitioners relates to the specific words, phrases and behaviours that they should use in unexpected news delivery situations1. Whilst principles such as compassion and sensitivity may be widely recognised, it is not possible to communicate in principles and parents who receive unexpected news often recall the exact words their ultrasound practitioner used. One study found that trainee sonographers carefully observed the language and behaviours of qualified staff in practice and selected those they believed reflected best practice. However, this approach has limitations. First, it is demanding of energy and cognitive resources, as each trainee is effectively tasked with constructing their own ‘best practice’ guidelines. Second, if the qualified sonographers in a department offering a placement are not using phrases which reflect best practice, trainees may learn these phrases and poor practice will be replicated. Third, there is a wide array of potential news delivery scenarios that a sonographer may encounter during their career; it is unlikely they will have the opportunity to observe each of these during their training placements.

The lack of consensus regarding appropriate words, phrases and behaviours in news delivery also has negative implications for practice improvement. Until recommendations are clear and transparent, it is not possible to discuss, test and refine these. The current project addressed this issue by generating detailed consensus guidelines regarding best practice for news delivery in obstetric ultrasound. It aimed to create recommendations which healthcare professionals, policy experts, expectant parent representative groups, lay experts and academics agreed were appropriate. The broader goal was to make recommendations for news delivery in obstetric ultrasound explicit, such that these can be reviewed, discussed and tested by subsequent research, to enable ongoing improvement in future. The guidance focused on UK Early Pregnancy Unit (EPU) and Fetal Anomaly Screening Programme (FASP) settings, where unexpected news is delivered by sonographers and ultrasound practitioners as standard.

To read the full guidance please click here

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