Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences

Judith Johnson,Maria Panagioti,Alice Dunning,Eve C Karkowsky,Samantha Thomas,Jane Arezina,Raabia Sattar

doi:10.1002/sono.12213

Abstract

AbstractExpectant parents report negative experiences of receiving unexpected news via ultrasound. There is a need to improve communication in this setting, but a lack of understanding on how to achieve this. This systematic review aimed to synthesise findings from qualitative studies exploring experiences of expectant parents or healthcare professionals when a fetal abnormality or unexpected finding was identified via ultrasound. MEDLINE, EMBASE, CINAHL and PsycINFO were searched using three blocks of terms (fetal abnormalities; ultrasound; experiences). Qualitative studies exploring the disclosure of pregnancy complications during ultrasound examinations were included and analysed using meta‐ethnographic synthesis. The review was conducted according to PRISMA and eMERGe guidelines. The review identified 28 studies. News delivered via ultrasound can be viewed as a journey involving five phases (expectations of ultrasound scans; discovery; shock; decisions and planning; adaptation). How well this is navigated depends upon the extent to which information needs and support needs are met. Ultrasound is a uniquely challenging situation to communicate difficult news as there is the potential for news to be communicated immediately. Care quality could be improved by the provision of written information and the use of correct terminology to describe abnormalities.

Highlights

Around 12% of pregnancies end in miscarriage or stillbirth and in 5% an anomaly is identified.[1,2,3] Ultrasound is a key tool for identifying or confirming these complications.[4]
This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Table S1)
The number of obstetricians included in the studies within the review was 34, the number of nurses and midwives was 13 and there were 9 sonographers

Summary

Introduction

Around 12% of pregnancies end in miscarriage or stillbirth and in 5% an anomaly is identified.[1,2,3] Ultrasound is a key tool for identifying or confirming these complications.[4]. The communication of pregnancy complications identified via ultrasound varies across health systems and organisations; parents may be informed immediately by the healthcare professional (HCP) conducting the scan or later informed by their referring physician.[7] Studies suggest that parents continue to report low overall satisfaction with care at this point,[8] experiencing insensitive language from staff,[9] delays in receiving information[10] and feeling confused.[11] HCPs describe these events as challenging; they struggle to manage parents' distress and report vicarious grief.[12] and the Meta-Ethnography Reporting Guidelines (eMERGe; Table S2).[16,17] The protocol was registered on PROSPERO (registration number: CRD42017073000; URL: https://www.crd.york.ac.uk/ PROSPERO/display_record.php?RecordID=73000; Appendix S1)

Methods

Results

Conclusion