Clinician communication after discovery of a soft marker of aneuploidy during pregnancy: A mixed methods assessment of a communication workshop

Abstract

BackgroundSoft markers of aneuploidy are common findings on obstetric ultrasounds but disclosure often increases patient anxiety. It is unknown whether communication training affects patient experience of soft marker disclosure. Our objective was to evaluate clinician experience of a simulation-based communication workshop and assess workshop influence on patient anxiety, understanding, and perception of communication quality. MethodsWe implemented a communication workshop for clinicians at an academic institution in 2019, and assessed clinician anxiety and confidence with counseling before and after. To assess effect of the workshop on patients, we surveyed pregnant people before and after workshop implementation for whom an echogenic intracardiac focus, choroid plexus cyst, or urinary tract dilation was identified. The primary outcome was anxiety. Some respondents completed a semi-structured interview. Interviews were analyzed using thematic analysis. ResultsTwelve clinicians participated. Twenty-one out of 49 eligible patients (43%) completed a survey before the workshop and 40 out of 90 eligible patients (44%) completed a survey after. The risk of high anxiety after was similar to before the workshop (aRR 1.7, 95% CI 0.6–4.2). Twenty patients were recruited for an interview. Qualitative analysis revealed that patients’ backgrounds, emotional impact of the conversation and clinician manner influenced perception of communication quality. ConclusionWhile a single clinician workshop did not affect patient anxiety, clinician manner and personalization play a large role in perception of counseling about soft markers of aneuploidy.