Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
Boston Children's Hospital Immersive Design Systems, Center for Life Sciences Building, 18th Floor, 3 Blackfan Circle, Boston, MA 02115, USA; Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Boston Children's Hospital, Boston MA 02115, USA.
J Gynecol Obstet Hum Reprod. 2023 Nov;52(9):102652. doi: 10.1016/j.jogoh.2023.102652. Epub 2023 Aug 24.
Soft 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.
We 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.
Twelve 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.
While 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.
软指标非整倍体是产科超声的常见发现，但披露通常会增加患者的焦虑。目前尚不清楚沟通培训是否会影响患者对软指标披露的体验。我们的目的是评估临床医生在基于模拟的沟通工作坊中的经验，并评估工作坊对患者焦虑、理解和沟通质量感知的影响。
我们在 2019 年为学术机构的临床医生实施了一项沟通工作坊，并在前后评估了他们进行咨询的焦虑和信心。为了评估工作坊对患者的影响，我们在工作坊实施前后对患有心室内回声增强、脉络丛囊肿或尿路扩张的孕妇进行了调查。主要结果是焦虑。一些受访者完成了半结构化访谈。使用主题分析对访谈进行了分析。
12 名临床医生参加了。在工作坊之前，49 名符合条件的患者中有 21 名（43%）完成了调查，在工作坊之后，90 名符合条件的患者中有 40 名（44%）完成了调查。工作坊后高焦虑的风险与工作坊前相似（ARR1.7，95%CI0.6-4.2）。20 名患者接受了访谈。定性分析显示，患者的背景、对话的情绪影响和临床医生的态度影响了对软指标非整倍体咨询的沟通质量感知。
虽然单次临床医生工作坊并未影响患者的焦虑，但临床医生的态度和个性化在感知软指标非整倍体咨询方面起着重要作用。
