Providing Mothers with Tapes of Neonatologists’ Discussions Improves Recall

Abstract

Source: Koh THHG, Butow PN, Coory M, et al. Provision of taped conversations with neonatologists to mothers of babies in intensive care: randomized controlled trial. BMJ. 2007;334:28–34; doi:10.1136/bmj.39017.675648.BEParents of infants in neonatal intensive care units (NICUs) may have difficulty recalling information given to them. Some studies of adults with cancer show improvements in psychological distress, anxiety, satisfaction, and information recall when provided with an audiotape of their initial conversations with the oncologist.1,2 Australian investigators performed a randomized, single-blind study of 200 mothers of babies admitted to a North Queensland NICU between July 1999 and December 2001. After completing an initial questionnaire eliciting personal information, anxiety scores, and preferences regarding information and involvement in decision-making, mothers were randomized to either receive a tape recorder and copy of the audiotapes of their initial and any subsequent important conversations with a neonatologist (n=102) or to a control group (conversations recorded but audiotape not provided to mother, n=98). Mothers were tested for recall of information, views about the use of the audiotapes, satisfaction with the conversations, postnatal depression, anxiety scores, general health, and stress about parenting at 10 days, four months, and 12 months.Most (96%) mothers in the tape group listened to the audio-tape at least once. Many stated the tapes “helped their understanding.” At 10 days and four months, mothers with audiotapes recalled significantly more information about diagnosis, treatment, and outcome than mothers in the control group. Six mothers, all in the control group, could not recall any information from the conversations. There were no significant differences found between the groups with regard to satisfaction with conversations, postnatal depression, anxiety scores, general psychological well-being, or parenting stress. Mothers of infants with a poor outcome who received tapes, however, were significantly more satisfied with their conversations. The authors conclude that providing mothers of babies in the NICU with audiotapes of their conversations with the neonatologist enhances their ability to recall important information about their baby’s condition. They recommend the use of a good quality tape recorder, a quiet room, use of clear language, and retention of a copy of the tape.Dr. Mears has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Medical decision-making authority “is increasingly seen as…shared by equal partners in the…physician-surrogate relationship.”3 Physicians have both ethical and legal obligations to obtain informed parental permission for medical interventions.3 For this permission to be informed, parents must understand the diagnosis, the risks and benefits of diagnostic and therapeutic interventions, and the availability of treatment options, including nontreatment. Physicians must assess parental understanding, decision-making capacity, and the parent’s ability to make a decision free of coercion or manipulation. As the accompanying editorial states, this Australian trial is limited by its short time span and lack of benefit for measured outcomes other than recall.4 If our goal is improved understanding, that may be enough.Communicating effectively with the parents of a sick child may be difficult under the stressful conditions of a NICU.4,5 Poor communication may interfere with a parent’s ability to make medical decisions and increase dissatisfaction and the potential for litigation.4,5 Verbal communication can be supplemented by written material and illustrations, but such materials are often written at relatively high reading levels.6,7 Other methods such as video or internet-based materials may be costly to produce.8 Audiotapes are accessible and inexpensive but are limited by the availability of recording equipment, decisions about what is to be recorded, the reluctance of some individuals to be taped, and the need for archiving.4,6