With Very Sick Infants, Doctors and Parents Often Miscommunicate

Mothers often have different impressions of their babies' condition than physicians meant to convey

By Mary Elizabeth Dallas

Thursday, August 16, 2012

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THURSDAY, Aug. 16 (HealthDay News) -- Misunderstanding is common between doctors and mothers of seriously ill newborns, according to a new study.

This breakdown in communication could not only increase parents' stress, researchers said, but could also interfere with treatment decisions.

Doctors and parents alike often are unaware of the problem, said researchers at the Johns Hopkins Children's Center in Baltimore.

"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," lead investigator Dr. Stephanie de Wit, a former neonatology fellow at Johns Hopkins, said in a center news release.

In conducting the study, the researchers questioned more than 100 mothers with newborns in the neonatal intensive-care unit and their children's clinicians about the baby's condition and prognosis.

The study revealed that 89 percent of clinicians, including doctors, neonatal nurse practitioners, nurses and respiratory therapists, described their discussions with the babies' mothers as productive. Although 92 percent of the mothers felt the same way, the researchers determined that discussions were not effective.

Nearly all of the mothers could name at least one of their child's conditions, but half of them did not agree with their child's doctor about the severity of their baby's illness, the study showed. Of these mothers, 63 percent thought their child was not as sick as their doctor thought. In some cases, the mothers of infants with a life-threatening condition thought their baby was "not sick," "somewhat sick" or "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," said de Wit, who is now an attending neonatologist at MedStar Franklin Square Medical Center in Baltimore. She explained that mothers may associate the word "sick" with vomiting or fever, while a doctor may use it to describe a very serious condition.

To improve communication with parents, the study authors advised doctors and nurses caring for newborns to take the following steps:

Update parents often about their baby's treatment.
Be direct and clear about the baby's condition, treatments and prognosis.
Do not use complex medical terms.
Be specific and explain even the most basic conditions.
Show compassion and sympathy.
Ask parents questions or have them recap the discussion to make sure they understand their child's condition and prognosis.

Mothers' hope could cloud their judgment when it comes to their child's condition, the researchers 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," the study's senior investigator, Dr. Renee Boss, a neonatologist at Johns Hopkins Children's Center, said in the news release.

"One thing that we, as 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," Boss said.

The study's authors said their findings highlight the need for doctors and nurses to carefully assess mothers' understanding of their baby's medical problems and communicate regularly with families to help parents become more involved in their child's care.

The study was published Aug. 16 in the Journal of Perinatology.

SOURCE: Johns Hopkins Medicine, news release, Aug. 16, 2012

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