Abstract
BackgroundBreaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. In Saudi Arabia, BBN about newborns is performed according to the parental preferences that have been reported from non-Arabic/non-Islamic countries. Saudi mothers' preferences about BBN have not yet been studied. Therefore, we aimed to elicit the preferences of Saudi mothers about BBN concerning newborns.MethodsWe selected a convenience sample of 402 Saudi mothers, aged 18-50 years, who had no previous experience with BBN. We selected them via a simple number-randomization scheme from the premises of a level III Saudi hospital between October of 2009 and January of 2011. We used a hypothetical situation (BBN about trisomy 21) to elicit their preferences about BBN concerning newborns via a structured verbal questionnaire composed of 12 multiple-choice questions. We expressed their preferences as percentages (95% confidence interval), and we used the Kendall's W test (W) to assess the degree of agreement in preferences.ResultsThe Saudi mothers preferred that BBN be conducted with both parents together (64% [60-69]), albeit with weak levels of agreement (W = 0.29). They showed moderate agreement in their preferences that BBN should be conducted early (79% [75-83], W = 0.48), in detail (81% [77-85], W = 0.52), in person (88% [85-91], W = 0.58), and in a quiet setting (86% [83-90], W = 0.53). With extremely weak agreement, they preferred to have a known person present for support during BBN (56% [51-61], W = 0.01), to have close bodily contact with their babies (66% [61-70], W = 0.10), and to have no another patients present (64% [59-68], W = 0.08). They showed moderate levels of agreement in their desires to detail, in advance, their preferences about process of BBN by giving a reversible, written informed consent that could be utilized for guidance, if needed (80% [76-84], W = 0.36).ConclusionsIn our experience, Saudi mothers' preferences about BBN concerning newborns are varied, suggesting that a "one-size-fits-all" approach is inappropriate. A reversible, written informed consent detailing their preferences about BBN that would be kept in their medical records and utilized for guidance, if needed, may be the best solution, given this level of diversity. These findings merit further study.
Highlights
Breaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma
These reasons included the following: they were discharged and on their way home (n = 11), they were tired after the delivery (n = 9), or they felt that the topic was too frightening (n = 8)
All of the participants were urban from the Al-Ahsa area; 32.6% were originally Bedouin or from other areas of Saudi Arabia
Summary
Breaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. Most of these reports have surveyed parents about previous experiences with BBN; their findings may represent a mixture of information regarding the process of BBN and reports influenced by the prior receipt of bad news It is unknown whether these preferences, originating from developed countries with diverse cultural contexts, apply to mothers from a conservative, Arabic/Islamic developing country. The fourth factor is the general, heuristic recommendations for BBN about serious diseases from the Saudi Commission for Health Specialists (SCHS) [8] To help address this ethical dilemma more competently and effectively, we conducted this cross-sectional survey to elicit Saudi mothers’ preferences about BBN concerning newborns and to assess the degree of agreement on these preferences
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