Field Natalie K, Venkatesan Charu, Gano Dawn, Agarwal Sonika, Young Kathleen A, Wheeler Sarahn, Russ Jeffrey B, Lemmon Monica E
Duke University School of Medicine, Durham, NC, USA.
Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Res. 2025 Jan 14. doi: 10.1038/s41390-025-03805-8.
Clinicians may face an array of challenges in conducting fetal neurological consultations including prognostic uncertainty, a lack of training in fetal counseling, and limited opportunity to build rapport with families. In this setting, it is critical to employ high-quality, family-centered care to allow expectant parents to make informed decisions. Despite the challenges and gravity of these consultations, there remains limited data outlining best conduct and communication practices. This narrative review aims to summarize relevant literature around counseling within fetal neurology, focusing on three key themes: (1) discussing neurological prognosis and uncertainty, (2) navigating evolving decision making, (3) recognizing bias and understanding patient context. We provide practical recommendations to clinicians conducting fetal neurological counseling and outline future research priorities. IMPACT: Fetal neurological conditions can have a significant impact on child short- and long-term health outcomes. Prenatal consultations are an important venue to discuss information regarding fetal prognosis and decision making with expectant parents. However, there is limited evidence supporting best communication practices within this setting. This review summarizes current literature around expectant parent prognostic communication preferences and outlines practical recommendations and priorities for future research.
临床医生在进行胎儿神经科会诊时可能会面临一系列挑战，包括预后的不确定性、缺乏胎儿咨询方面的培训以及与家庭建立融洽关系的机会有限。在这种情况下，采用高质量的以家庭为中心的护理至关重要，以便准父母能够做出明智的决定。尽管这些会诊具有挑战性且十分严肃，但概述最佳行为和沟通做法的数据仍然有限。本叙述性综述旨在总结胎儿神经学领域咨询相关的文献，重点关注三个关键主题：（1）讨论神经学预后和不确定性；（2）应对不断变化的决策过程；（3）认识偏见并了解患者背景。我们为进行胎儿神经科咨询的临床医生提供实用建议，并概述未来的研究重点。影响：胎儿神经疾病会对儿童的短期和长期健康结果产生重大影响。产前会诊是与准父母讨论胎儿预后信息和决策的重要场所。然而，在这种情况下，支持最佳沟通做法的证据有限。本综述总结了当前关于准父母预后沟通偏好的文献，并概述了实用建议和未来研究的重点。
