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Published on: September 19, 2019
Breaking bad news: what parents would like you to know
Marije A Brouwer1, Els L M Maeckelberghe2, Agnes van der Heide3
1Department of Pediatrics, University Medical Center Groningen, Groningen, Netherlands m.a.brouwer@umcg.nl.
Insights
Parents experienced significant barriers when healthcare professionals communicated bad news about their child's life-threatening condition. Improving communication timing and clarity is crucial for better parental support during difficult times.
Area of Science:
- Pediatric healthcare communication
- Palliative care communication
- Qualitative research in medicine
Background:
- Breaking bad news is a critical aspect of pediatric care for children with life-threatening conditions.
- Understanding parental experiences in these communication scenarios is limited.
- Effective communication is vital for supporting families facing severe diagnoses.
Purpose of the Study:
- To analyze parents' experiences, identifying barriers and facilitators in the communication of bad news.
- To provide insights into how healthcare professionals can improve bad news delivery to parents of critically ill children.
- To enhance the quality of communication in pediatric end-of-life care.
Main Methods:
- A qualitative study employing constant comparative analysis.
- In-depth interviews were conducted with parents of children with life-threatening conditions.
- Data from 64 parents (bereaved and non-bereaved) of 44 children were analyzed.
Main Results:
- Ten key barriers were identified, including lack of timely communication, physicians not seeking parental input, and parental unpreparedness.
- Parents reported issues with clarity on future treatment, physicians not voicing uncertainties, and inadequate follow-up conversations.
- Misunderstanding medical terminology and parental concerns about informing children were also significant barriers.
Conclusions:
- Healthcare professionals must address practical communication aspects to improve bad news delivery.
- Parents perceive the timing of critical conversations as often too late, or non-existent.
- Study findings offer actionable strategies to better meet parental needs during difficult medical communications.
Objective:
Breaking bad news about life-threatening and possibly terminal conditions is a crucial part of paediatric care for children in this situation. Little is known about how the parents of children with life-threatening conditions experience communication of bad news. The objective of this study is to analyse parents' experiences (barriers and facilitators) of communication of bad news.
Design:
A qualitative study consisting of a constant comparative analysis of in-depth interviews conducted with parents.
Setting:
The Netherlands.
Participants:
Sixty-four parents-bereaved and non-bereaved-of 44 children (aged 1-12 years, 61% deceased) with a life-threatening condition.
Interventions:
None.
Results:
Based on parents' experiences, the following 10 barriers to the communication of bad news were identified: (1) a lack of (timely) communication, (2) physicians' failure to ask parents for input, (3) parents feel unprepared during and after the conversation, (4) a lack of clarity about future treatment, (5) physicians' failure to voice uncertainties, (6) physicians' failure to schedule follow-up conversations, (7) presence of too many or unknown healthcare professionals, (8) parental concerns in breaking bad news to children, (9) managing indications of bad news in non-conversational contexts, and (10) parents' misunderstanding of medical terminology.
Conclusions:
This study shows healthcare professionals how parents experience barriers in bad news conversations. This mainly concerns practical aspects of communication. The results provide practical pointers on how the communication of bad news can be improved to better suit the needs of parents. From the parents' perspective, the timing of conversations in which they were informed that their child might not survive was far too late. Sometimes, no such conversations ever took place.
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