Breaking bad news during prenatal ultrasound screening

Breaking bad news during prenatal ultrasound screening

Mosconi L. (1,2), Ravaldi C. (1,3), Vannacci A. (1,4)

(1) CiaoLapo, Charity for Healthy Pregnancy and Perinatal Loss Support, Prato, Italy; (2) School of Psychology, University of Florence, Florence, Italy; (3) Department of Health Sciences, University of Florence, Florence, Italy; (4) Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy;

Background:
Breaking bad news during pregnancy is a difficult matter for health practitioners and only a few studies tell us which specific communication skills they need. This study reviewed current literature and suggests a guideline on how to break bad news during prenatal ultrasound screening.

Methods:
We reviewed all studies published between 1990 and 2017, written in English, and indexed in Medline, PsycNET and Google Scholar databases. We included all studies on: (1) breaking bad news during ultrasound, (2) communication during screenings and examinations, and (3) patient-centred care. Studies concerning the father’s exclusive point of view and studies with no ob/gyn bibliographic background were excluded. We suggested a guideline based on the SPIKES (Setting, Perception, Invitation/Information, Knowledge, Empathy, Summarize/Strategize) protocol that breaks down the communication process in three moments: “before”, “during” and “after” the diagnostic exam.

Results:
This narrative review shows how the communication modality affects patients’ well-being and their grieving process. The emerging concept of “Grieving multiple losses” is an important one: parents who receive a life-threatening foetal diagnosis grieve both the loss of a healthy baby and their prospect of future parenting. Patients often feel alone and stigmatized by relatives and friends, so they look for support from health care practitioners, who need to know parents’ needs to better break bad news without grounding their knowledge on stereotypes. Based on this review, we created a step-by-step guideline that provides easy to follow recommendations and “dos and don’ts”, tailored to prenatal ultrasound screenings.

Conclusion:
Starting from results of our literature review, we created a new communication guideline for healthcare providers. Further research could validate its use in a clinical setting.

Ethics Statement:
No subject was enrolled in this study; approval from the ethics committee was not required.

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