Prognostic Discordance Among Parents and Physicians Caring for Infants with Neurologic Conditions

Area of Science:

• Pediatric Neurology
• Clinical Communication
• Medical Prognosis

Background:

• Prognostic communication is crucial for families of infants with neurologic conditions.
• Understanding discrepancies in parental and physician expectations is vital for effective care planning.

Purpose of the Study:

• To assess the frequency, severity, and nature of prognostic discordance between parents and physicians for infants with neurologic conditions.
• To identify whether discordance arises from differences in understanding or belief.

Main Methods:

• An observational cohort study involving 40 parent-physician dyads of infants with neurologic conditions.
• Postconference surveys assessed expected neurologic outcomes (motor, speech, cognition) on a 6-point scale.
• Prognostic discordance was defined as a difference of ≥2 response options.

Main Results:

• Seventy percent (28/40) of dyads showed prognostic discordance in at least one domain.
• Discordance was predominantly moderate (82%) and equally frequent across motor, speech, and cognitive domains.
• Differences in understanding (89%) were more common than differences in belief (21%), with parents generally being more optimistic.

Conclusions:

• Significant prognostic discordance exists between parents and physicians for infants with neurologic conditions.
• This discordance is often rooted in differing understandings and, to a lesser extent, beliefs.
• Findings support the development of interventions to enhance prognostic communication and align expectations.