"Like a Hot Potato": Breakdown of Clinician-Parent Communication About Newborn Toxicology Testing

Examine the perspectives of newborn clinicians and parents on communication around newborn toxicology testing.

We conducted semistructured interviews from 2021 to 2022 with 15 newborn clinicians and 15 parents who experienced perinatal toxicology testing. Clinician interviews explored indications, perceptions of use, and attitudes toward parental consent for newborn toxicology testing. Parental interviews explored attitudes toward, knowledge of, and care team interactions related to perinatal toxicology testing. Researchers open coded transcripts for clinician and parent interviews separately to generate 2 codebooks. Transcripts were independently coded by 2 pairs of researchers. Codes involving communication and clinician-parent relationship from both groups were analyzed together using an inductive thematic analysis approach.

From both sets of interviews, we identified 4 themes: (1) lack of communication about the benefits and risks of newborn toxicology testing led to confusion and misperceptions about the purpose of testing among parents, (2) fear of damaging the clinician-parent relationship and discomfort discussing potential Child Protective Services involvement impacted clinician communication around testing, (3) both clinicians and parents expressed a desire for more transparent communication around newborn toxicology testing, and (4) participants suggested structured consent conversations and improved coordination across prenatal and perinatal care teams.

Newborn clinicians rarely discussed clinical benefits of newborn toxicology testing with parents. Both parents and clinicians offered suggestions for improving the transparency and structure of toxicology testing discussions.