Article Figures & Data
Figures
- FIGURE 1
Communication strategies when communicating with parents of an unstable child at risk for dying. Example of a “time-out checklist” filled by the resident taking care of Caleb.
Tables
Junior Residents Senior Residents Neonatologists and Fellows Transport Team and NNPs Technical scores, scored on 100, mean (SD) 77 (9) 82 (8) 82 (8) 88a (6) Overall performance, scored on 10, median (IQR) 7 (6–8) 7 (6–8) 8a (6–10) 7 (5–9) Communication with parents during the resuscitation, scored on 10, median (IQR) 8 (7–9) 7 (6–9) 8 (6–10) 6 (5–8) Communication with parents after the resuscitation, scored on 10, median (IQR) 7 (6–8) 7 (6–8) 8a (9–10) 8b (8–10) Interactions With Parents Before a Resuscitation Examples Quotes From Evaluators or Examples of Participants’ Interactions Reported by Evaluators Examples of Behaviors To Adopt Examples of Behaviors To Avoid Acknowledge parents and introduce yourself “He established eye contact, the parents knew he was there.”
“Spoke in clear terms. 'Mr and Mrs Smith, I am Melanie, the baby doctor.'”“She didn’t even look at the parents, totally ignored them.”
“A neonatologist, normal people don’t know what that is.”Know and use the name of the infant “She asked if they had a name and used it.”
“We will be there for Beatrice when she is born.”“He messed up the sex of the baby. It was indicated the baby was a girl on the instructions.” Prepare the parents:
what is about to happen;
time constraints;
you are there“He prepared the parents for what was about to come and that they may not have much time to speak later.”
“Beatrice could need some help at birth. We always prepare for the worst but hope for the best. Sometimes, we cannot talk to parents much when we help babies, but we are there for you.”“She said everything would be okay without looking at the parents.”
“She said ‘don’t worry’ in a carefree way.”
“He said everything was under control when it was clear it wasn’t.”Positive Interactions With Parents During the Resuscitation Quotes From Evaluators or Examples of Participants’ Interactions Reported by Evaluators Examples of Behaviors To Adopt Examples of Behaviors To Avoid Acknowledge the presence of the parents; let the father approach the bed Use the name of the infant "She told the dad he could take his baby’s hand."
"He told the father to come closer.”"Stay where you are, we don’t have time to speak to you.”
“Don’t touch your baby."Use the name of the infant "He continued using the name of the baby." "He said 'your son' when it was a daughter." Prepare parents for the death in 2–3 steps “"She prepared parents for the death in several clear steps. Said it was not going well and that she hoped Beatrice would improve, then that she was trying a last dose and if it didn’t work, Beatrice would die. Then she told them Beatrice was dead, that they did everything they could." "It was very unclear what was going on. She seemed overwhelmed, then said the heart did not come back. It was unclear if the baby had died and when." Say the words (“death,” “dying”) "It was clear, he said they did their best, but that she died, Beatrice was dead. He used the words." "'She is with the angels?' Really?"
"'She was born with no heart?' Who understands that?"Remain calm "She was confident, I would trust her." "He was jumping up and down and losing it." Do not ask for parents’ permission to stop resuscitation "It was clear they had done all they could, and she said it was time to stop." "'Do you think it is a good time to stop?' Really?" "
He asked the parents if he should stop."Quotes From Evaluators or Examples of Participants’ Interactions Reported by Evaluators Examples of Behaviors To Adopt Examples of Behaviors To Avoid Positive interactions with parents after the resuscitation Clearly state the child died “She is dead, I am sorry.” “He just said it was tragic but did not mention death once.” Avoid medical jargon related to death “We tried everything we could to save her life, but it didn’t work. She is dead.” “She was born without a heart; it never came back.” Tell parents they could not have prevented the death “There is nothing you could have done to prevent this.” “She told the parents it was a shame they did not come to the hospital earlier.” Listen and provide moments of silence “She spoke slowly, listened; there were many pauses.” “He just wouldn’t stop speaking. Parents couldn’t get a word in.” Provide proximity Provider-parent “The doctor was sitting on a chair, at the same level as the mom in her bed.” “She was standing up, in the corner, with no eye contact.” Provider-infant “He took the baby in his arms and you could tell he cared.” “He just left the baby naked on the table when he went to speak to the parents.” Parent-infant “She placed Beatrice in the parents’ arms, placed all 4 hands together, after telling them she would.” “She spoke to Dad alone, then went to speak to Mom, and the baby was alone on the table, dead. Everybody was alone.” Be knowledgeable about what happens after death “He knew what happened to the body, the practical aspects after death.” “He had no idea about the body and the next steps: did not inspire trust.” Offer “formal” support “She said she would call the psychologist.” “She just left the room.” Offering future support “I will always be there in the future if you have questions.” “She ended abruptly, did not offer follow-up.” Proportion of Participants Adopting the Following Positive Behaviors In the Top 10, % Not in the Top 10, % Throughout the resuscitation Used name of infant** 90 62 Before the resuscitation Introduced themselves 100 78 Mentioned the resuscitation could be difficult 100 80 Mentioned that communication during resuscitation would be difficult 100 80 During the resuscitation Allowed father to approach the bedside** 90 62 Acknowledged the presence of the father** 90 62 Encouraged the father to report back to the mother 80 62 Acknowledged the presence of mother 100 100 Prepared parents for the death in a stepwise fashion* 100 65 Stopped resuscitation <15 min 100 80 Took the decision to stop the resuscitation (did not ask parents) 100 80 Stated clearly that the infant was dead** 90 50 Noted time of death 90 78 After the death Stated there was nothing parents could have done to prevent this** 100 65 Placed the infant in the mother or the father’s arms 100 71 Touched the mother 90 90 Sat down* 70 29 Allowed opportunity for parents to ask questions (30 s silence) 100 80 Knew what happened to the body after death** 100 31 Offered creation of souvenirs 90 90 Offered to call family or spiritual supports 100 78 Offered future support* 100 65
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Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology
