Talk smoothes the way to better understanding sick babies

Aug 20 2012

By Piriya Mahendra, MedWire Reporter

Clinicians must foster improved communication with the mothers of critically ill newborns to improve understanding of their child's condition, research suggests.

Renee Boss (Johns Hopkins University, Baltimore, Maryland, USA) and team found that miscommunication was common between the mothers of newborn babies admitted to intensive care and the clinicians treating them. The most serious breakdown in communication occurred when mothers and clinicians discussed the severity of the baby's condition.

The study of 101 mother-clinician pairs revealed that most mothers and clinicians (89 and 92%, respectively) felt that their discussions had gone well. In fact, only one mother-clinician pair agreed that the discussions had gone poorly.

In this case, the clinician reported that the mother seemed uninterested in the infant's condition and the mother reported that she did not understand what she was being told.

However, using the clinician's assessment of the severity of the infant's illness as a reference, almost half (45%) of mothers and clinicians disagreed on the child's illness severity.

Of the mothers who disagreed with the clinician's estimate of illness severity, nearly two-thirds of them (62.5%) believed their child to be less sick than the clinician did.

Nearly all mothers (94 of 101) could name at least one of their child's diagnoses and treatments. However, mothers of children with serious or life-threatening conditions such as sepsis, extreme prematurity, or bladder exstrophy did not seem to be aware of the severity of these conditions, and described their babies as "not sick," "somewhat sick," or even "pretty healthy."

"When it comes to discussing a critically ill newborn's condition, parents and doctors often seem to be speaking the same, yet different, languages," remarked lead author Stephanie de Wit, also of Johns Hopkins University in a press statement.

"One thing that we, clinicians, must always keep in mind is that talk doesn't equal communication, and just because we spoke with a parent we cannot assume that our message got across," said Boss.

Communication breakdown could hamper critical short- and long-term treatment decisions and aggravate already high levels of parental stress, the authors explained.

"Poor understanding of a baby's prognosis can lead to maternal frustration and dissatisfaction with the treatment plan, which ultimately undermines the goal of teamwork between families and clinicians," said de Wit.

However, Boss pointed out: "We cannot exclude the possibility that the sheer force of hope fueled unrealistically optimistic expectations, even when mothers fully grasped the objective reality of their child's condition."

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