Harvey M E, Redshaw M E
Department of Perinatal Imaging and Health, Division of Imaging and Biomedical Engineering, King's College, London, UK National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
BMJ Open. 2016 Sep 26;6(9):e011472. doi: 10.1136/bmjopen-2016-011472.
To explore communication and interaction between parents and clinicians following neonatal ultrasound (US) and MRI of the brain of babies born preterm.
This qualitative study was undertaken as part of a larger UK study of neonatal brain imaging. 511 infants were cared for in 14 London neonatal units with MR and cerebral US imaging in a specialist centre.
Parents with infants born at <33 weeks gestation were randomised to receive prognostic information based on either MRI or US findings on their infants at term-corrected age.
Discussions between parents and clinicians about the MRI or US result were audio recorded. Parents were told about the findings and their baby's predicted outcome. A topic guide ensured essential aspects were covered. Recordings were fully transcribed. Discussion of the scan results, the content and style of the interaction and parental response were analysed qualitatively in 36 recordings using NVivo V.10.
Key themes and subthemes were identified in the clinician-parent discussions.
The overarching theme of 'the communication interface' was identified with three key themes: 'giving information', 'managing the conversation' and 'getting it right' and further subthemes. A range of approaches were used to facilitate parental understanding and engagement. There were differences in the exchanges when information about an abnormal scan was given. The overall structure of the discussions was largely similar, though the language used varied. In all of the discussions, the clinicians talked more than the parents.
The discussions represent a difficult situation in which the challenge is to give and receive complex prognostic information in the context of considerable uncertainty. The study highlights the importance of being able to re-visit specific issues and any potential areas of misunderstanding, of making time to talk to parents appreciating their perspective and level of knowledge.
EudraCT 2009-013888-19; Pre-results.
探讨早产儿脑部新生儿超声（US）和磁共振成像（MRI）检查后家长与临床医生之间的沟通与互动。
本定性研究是英国一项更大规模的新生儿脑成像研究的一部分。511名婴儿在伦敦的14个新生儿病房接受护理，并在一个专科中心进行了磁共振成像和脑部超声检查。
孕周小于33周出生的婴儿的家长被随机分配，根据其婴儿在矫正胎龄时的MRI或US检查结果接受预后信息。
家长与临床医生之间关于MRI或US检查结果的讨论进行了录音。向家长告知了检查结果及其婴儿的预测预后。一份主题指南确保涵盖了关键方面。录音被全部转录。使用NVivo V.10对36份录音中扫描结果的讨论、互动的内容和风格以及家长的反应进行了定性分析。
在临床医生与家长的讨论中确定了关键主题和子主题。
确定了“沟通界面”这一总体主题，包含三个关键主题：“提供信息”“掌控对话”和“做到正确”以及进一步的子主题。采用了一系列方法来促进家长的理解和参与。在给出异常扫描信息时，交流方式存在差异。讨论的总体结构大致相似，尽管使用的语言有所不同。在所有讨论中，临床医生比家长讲话更多。
这些讨论代表了一种困难的情况，即在存在相当大不确定性的背景下，给予和接收复杂预后信息是一项挑战。该研究强调了能够重新审视具体问题和任何潜在的误解领域、抽出时间与家长交谈并理解他们的观点和知识水平的重要性。
EudraCT 2009 - 013888 - 19；预结果。
