Boss RD, Donohue PK, Roter DL, Larson SM, Arnold RM. "This is a decision you have to make": using simulation to study prenatal counseling. Simul Healthc. 2012 Aug;7(4):207-12.
(Decision-Making, Prenatal, Standardized Patients, United States)
INTRODUCTION: Prenatal decision making during extremely preterm labor is challenging for parents and physicians. Ethical and logistical concerns have limited empirical descriptions of physician counseling behaviors in this setting and constricted opportunities for communication training. This pilot study examines how simulation might be used to engage neonatologists in reflecting on their usual prenatal counseling behaviors. METHODS: Neonatology physicians counseled a couple (standardized patients) with the female patient having impending delivery at 23 3/7 weeks. Encounters were videotaped. Physicians completed post encounter surveys and debriefing interviews. Mixed-methods analysis explored the outcomes of clinical verisimilitude and counseling behaviors. RESULTS: All 10 neonatology physicians found that the simulation was highly realistic and that their behaviors paralleled neonatologist self-report in other studies. Physicians contributed more than 80% of encounter dialogue and mostly focused on biomedical information related to the acute perinatal period. Physicians spent nearly a quarter of each encounter in building relationships and expressing empathy. Most physicians initiated discussion about quality versus quantity of life but infrequently elicited the parents' related goals and values. When medical factors and family preferences were held constant, physicians assumed variable responsibility for making decisions about resuscitation. Most physicians declined parent requests for treatment recommendations, although all of those physicians felt more than 75% certain about what should be done. CONCLUSIONS: Simulation can reproduce the decisional context of prenatal counseling for extremely premature labor. These results have implications for communication training in any setting where physicians and patients without established relationships must discuss acute diagnoses and make high-stakes medical decisions.
Hunfeld JA, Leurs A, De Jong M, Oberstein ML, Tibben A, Wladimiroff JW, Wildschut HI, Passchier J. Prenatal consultation after a fetal anomaly scan: videotaped exploration of physician's attitude and patient's satisfaction. Prenat Diagn. 1999 Nov;19(11):1043-7.
(Prenatal Consultation, Satisfaction and Recall, Netherlands)
The main aim of the study was to evaluate the relationship between the physician's attitude (using the non-verbal Global Affective Measure of the Roter Analaysis System and the Counselor Rating Form-short version) and the satisfaction of the pregnant women with the prenatal consultation. A secondary aim was to evaluate the women's recall of essential information (i.e. location, severity, prognosis and cause of the anomaly). To this end, 24 prenatal consultations (pregnant women, partners and physicians) were videotaped following a fetal anomaly scan, and a few days later, the pregnant women completed questionnaires to assess their perception of the physician's attitude and their satisfaction with the consultation and the extent to which they could recall the essentials of the information given about the fetal anomaly. In descending order, the physician's dominance/assertiveness (i.e. being self-confident and decisive) (assessment of the videotapes by two psychologists), trustworthiness (women's report) and expertise were significantly positively associated with the women's overall satisfaction, i.e. satisfaction with the information given and affective behaviour on the part of the physician during the prenatal consultation. All the women (n=24) recalled the essentials of the information given about the location of the fetal anomaly. The majority of them correctly reproduced the severity, the prognosis and the cause of the anomaly. Our findings indicate that women in whom a fetal anomaly has been detected derive particular benefit from a self-confident, decisive, expert and trustworthy physician.
Zecca G, Gradi EC, Nilsson K, Bellotti M, Dal Verme S, Vegni E, Moja EA. "All the rest is normal". A pilot study on the communication between physician and patient in prenatal diagnosis. J Psychosom Obstet Gynaecol. 2006 Sep;27(3):127-30.
(Prenatal Diagnosis, Italy)
The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.
Resources by Subject Area
Following are abstracts of RIAS studies through 2012, listed by subject area. Click on the subject name below to go directly to that section.
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