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Chérif L, Yaich K, Sahnoun C, Khemekhem K, Boudabbous J, HadjKacem I, Ayadi H, Moalla Y. Autisme : annonce du diagnostic et vécu des parents. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirshblum SC, Botticello AL, DeSipio GB, Fichtenbaum J, Shah A, Scelza W. Breaking the news: A pilot study on patient perspectives of discussing prognosis after traumatic spinal cord injury. J Spinal Cord Med 2016; 39:155-61. [PMID: 25897890 PMCID: PMC5072497 DOI: 10.1179/2045772315y.0000000013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE/BACKGROUND In spinal cord injury (SCI) medicine, informing a patient with a neurologically complete SCI of the poor prognosis ("bad news") for significant neurological recovery (e.g. ambulation) is difficult. Few guidelines exist for clinicians and the wishes of patients in receiving this information are currently not known. The goal of this pilot study was to determine when, by whom, and in what setting persons with neurologically complete traumatic SCI want to hear of their prognosis. METHODS Subjects with a >3 months motor complete SCI above T10 were recruited to complete an online survey, from three geographically different acute rehabilitation centers, to obtain retrospective information on their experiences of receiving poor prognosis. A mixed methods approach was used to obtain data on individual experiences and a combination of quantitative and qualitative analyses was used to assess patterns in individual responses. RESULTS 60 individuals were recruited for the study and 56 participants completed the survey. Most heard their prognosis from a physician, in the acute care hospital (61%), with the patient initiating the conversation (64%). Patient recommendations reveal that most individuals with traumatic SCI prefer to be given the poor prognosis for neurological recovery by a physician and early after injury. There were no differences in patient experience nor recommendations based on demographic background (i.e. sex, age, race, or education level). CONCLUSION The majority of patients surveyed report wanting to know their prognosis early after injury and to hear the information by a physician in a clear and sensitive manner. This study marks the first step towards defining how and when to break the news regarding poor prognosis for neurological recovery including ambulation after severe (neurological complete) traumatic SCI from the patients' perspective.
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Affiliation(s)
- Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Correspondence to: Steven C. Kirshblum, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
| | - Amanda L. Botticello
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Gina Benaquista DeSipio
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joyce Fichtenbaum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Akshat Shah
- Santa Clara Valley Medical Center, San Jose, CA, USA
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Abstract
When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model.
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Affiliation(s)
| | - Lonnie Gentry
- Department of Surgery, Baylor University Medical Center at Dallas
| | - Thomas R Cox
- Department of Surgery, Baylor University Medical Center at Dallas
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Lawrence Z. Black African parents’ experiences of an Educational Psychology Service. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2014. [DOI: 10.1080/02667363.2014.919249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abbott M, Bernard P, Forge J. Communicating a diagnosis of Autism Spectrum Disorder - a qualitative study of parents' experiences. Clin Child Psychol Psychiatry 2013; 18:370-82. [PMID: 22904114 DOI: 10.1177/1359104512455813] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Not enough is known about parents' experiences of receiving the news that their child warrants a diagnosis of Autism Spectrum Disorder (ASD). Sharing this information with parents is an important and difficult part of Child and Adolescent Mental Health (CAMH) practice. Qualitative methodology was used to explore the experiences of the 'feedback session' with nine sets of parents in a community Child and Adolescent Mental Health Service (CAMHS) in North East England. Parents gave vivid accounts of their experiences and described issues relating to the structure, style and content of the session. The experiences of CAMHS users should inform the development of good practice in this important area.
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Affiliation(s)
- Mandy Abbott
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Community CAMHS, 1st Floor, Benton House, 136 Sandyford Road, Sandyford, Newcastle upon Tyne, NE2 1QE, UK.
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Abstract
The disclosure to a family of a child's cerebral palsy is an important transformative event that has potential lasting implications. This article highlights specific challenges, the results of research into the disclosure process and what attributes should be sought for in this encounter by health care providers. Illustrative case vignettes are presented to concretely demonstrate the "dos and don'ts" of the disclosure. Suggestions will also be provided to improve the disclosure process.
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Chiu YN, Chou MC, Lee JC, Wong CC, Chou WJ, Wu YY, Chien YL, Gau SSF. Determinants of maternal satisfaction with diagnosis disclosure of autism. J Formos Med Assoc 2012; 113:540-8. [PMID: 25037759 DOI: 10.1016/j.jfma.2012.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE Diagnosis disclosure is an important clinical issue in developmental disabilities, which may influence parents' ability to cope with their child's conditions. This paper presents the content and patterns of diagnosis-informed counseling for mothers of children with autism and investigates the determinants for maternal satisfaction with this counseling, in order to improve clinical practice. METHODS Mothers of 151 children, aged 3-12 years, with DSM-IV autistic disorder, confirmed by the Chinese version of the Autism Diagnostic Interview-Revised, were assessed. We collected information about the mothers' experience with diagnosis-informed counseling, their personality characteristics, and the extent to which they were satisfied with the counseling. RESULTS Satisfaction with diagnosis-informed counseling was related more to the context of the counseling, including the attitude of the counselors and the timing and duration of counseling, than to its content. Parents' social desirability, educational level, and employment status were negatively associated with their satisfaction with counseling. However, immediate emotion, neuroticism, and extroversion did not have a significant effect on the satisfaction with counseling. Approximately 60% of the mothers preferred to be informed of having an autistic child after the diagnosis had been confirmed. CONCLUSION Our findings suggest that more efforts are needed to improve the quality of diagnosis-informed counseling in autism, particularly in the context of breaking the news to mothers of children with autism. Future study could further examine the moderating effect of diagnostic subtype of autism spectrum disorders, treatment response, or social support on maternal satisfaction with diagnosis-informed counseling (ClinicalTrials.gov number, NCT00494754).
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Affiliation(s)
- Yen-Nan Chiu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Miao-Chun Chou
- Department of Child & Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ju-Chin Lee
- Department of Psychiatry, Wan Fang Hospital, Taipei, Taiwan
| | - Ching-Ching Wong
- Taipei Child Assessment and Early Intervention Center, Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan
| | - Wen-Jiun Chou
- Department of Child & Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Yu Wu
- Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Abdelmoktader AM, Abd Elhamed KA. Egyptian mothers' preferences regarding how physicians break bad news about their child's disability: a structured verbal questionnaire. BMC Med Ethics 2012; 13:14. [PMID: 22747832 PMCID: PMC3411482 DOI: 10.1186/1472-6939-13-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 07/02/2012] [Indexed: 11/26/2022] Open
Abstract
Background Breaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability. Methods Mothers of 100 infants recently diagnosed with Down syndrome were interviewed regarding their preferences for how to be told bad news. Mothers were recruited through outpatient clinics of the Pediatric Genetics Department at Fayoum University Hospital (located 90 km southwest of Cairo, Egypt) from January to June 2011. Results and discussion Questionnaire analyses revealed nine themes of parental preferences for how to be told information difficult to hear. Mothers affirmed previously reported recommendations for conveying bad medical news to parents, including being told early, being told of others with a similar condition, and being informed of the prognosis. Conclusions Mothers affirmed communication themes previously discussed in the literature, such as being told early, and being informed of the prognosis. Although more research is needed in this important area, we hope that our findings will stimulate future search and help health care providers in different societies establish guidelines for effectively communicating bad news.
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Davis H, Tsiantis J. Promoting Children's Mental Health: The European Early Promotion Project (EEPP). INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2005.9721946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stasinos DP. Aspects of sexuality in greek adolescents with down syndrome. Int J Adolesc Med Health 2011; 7:241-248. [PMID: 22912199 DOI: 10.1515/ijamh.1994.7.3.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sheets KB, Best RG, Brasington CK, Will MC. Balanced information about Down syndrome: what is essential? Am J Med Genet A 2011; 155A:1246-57. [PMID: 21548127 DOI: 10.1002/ajmg.a.34018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 03/07/2011] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to explore the perspectives of genetic counselors and parents of children with Down syndrome to define essential information for the initial discussion of a new diagnosis. We compared information given in both prenatal and postnatal settings, and also aimed to distinguish differences between the informational needs of parents and the information genetic counselors provide. Online surveys were distributed to members of the National Down Syndrome Congress, National Down Syndrome Society, and National Society of Genetic Counselors. Participants included 993 parents of children with Down syndrome and 389 genetic counselors. Participants rated 100 informational features about Down syndrome as Essential, Important, or Not Too Important for inclusion in the first discussion of the diagnosis. Responses identified 34 essential informational items for the initial discussion of Down syndrome, including clinical features, developmental abilities, a range of prognostications, and informational resources. Healthcare providers should consider incorporating these items in their initial discussion of a diagnosis in both prenatal and postnatal settings. Statistically significant differences between parent and genetic counselor responses illustrate that information is valued differently and that parents appreciate information about the abilities and potential of people with Down syndrome, as opposed to clinical details. Balancing clinical information with other aspects of the condition, as well as a better understanding of the information parents consider most important, may enable healthcare professionals to more effectively satisfy families' informational needs following a new diagnosis of Down syndrome.
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Affiliation(s)
- Kathryn B Sheets
- Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Affiliation(s)
- Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Braiden HJ, Bothwell J, Duffy J. Parents' Experience of the Diagnostic Process for Autistic Spectrum Disorders. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/13575279.2010.498415] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Skotko BG, Capone GT, Kishnani PS. Postnatal diagnosis of Down syndrome: synthesis of the evidence on how best to deliver the news. Pediatrics 2009; 124:e751-8. [PMID: 19786436 DOI: 10.1542/peds.2009-0480] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Many parents of children with Down syndrome (DS) have expressed dissatisfaction with how they learned about their child's diagnosis. DS remains the most common chromosomal condition, occurring in 1 of every 733 births, with the majority of children still diagnosed postnatally. OBJECTIVE Our goal was to review systematically all available evidence regarding how physicians should approach the conversation in which they explain DS for the first time to new parents. METHODS We searched online databases from 1960 to 2008, including Medline and PsychInfo, as well as Web sites maintained by academic organizations (eg, American Academy of Pediatrics) and other nonprofit or private organizations (eg, the National Down Syndrome Society), by using the terms "Down syndrome," "trisomy 21," "mongolism," "prenatal diagnosis," "postnatal care," and "delivery of health care." Articles were selected that answered > or =1 research question, established a priori: (1) Who is the best person to communicate the news? (2) When is the best time to share the news? (3) Where is the best place or setting to deliver the news? (4) What information should be delivered? and (5) How should the news be communicated? All studies were evaluated for quality according to the method outlined by the US Preventative Services Task Force. Final recommendations were based on the strength of evidence. RESULTS Parents prefer to receive the diagnosis together in a joint meeting with their obstetrician and pediatrician. The conversation should take place in a private setting as soon as a physician suspects a diagnosis of DS. Accurate and up-to-date information should be conveyed, including information about local support groups and resources. CONCLUSION By implementing a few cost-neutral measures, physicians can deliver a postnatal diagnosis of DS in a manner that will be deemed by new parents as sensitive and appropriate.
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Affiliation(s)
- Brian G Skotko
- Division of Genetics, Department of Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
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Muggli EE, Collins VR, Marraffa C. Going down a different road: first support and information needs of families with a baby with Down syndrome. Med J Aust 2009; 190:58-61. [PMID: 19236288 DOI: 10.5694/j.1326-5377.2009.tb02275.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/24/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the experiences of families with a baby with Down syndrome at the time of diagnosis, and their preferences for information and support in the early period after diagnosis. DESIGN, SETTING AND PARTICIPANTS A qualitative, interview-based study of 18 families living in Victoria with a child with Down syndrome born between 2002 and 2004 who had not been diagnosed with the syndrome before birth. Interviews were transcribed verbatim and interpretive content analysis was undertaken. RESULTS Parental coping with the unexpected diagnosis of Down syndrome in their infant was influenced by the time interval between birth and disclosure of clinical suspicion of Down syndrome, the level of certainty of the attending physician at the time of disclosure, and the time interval between disclosure of clinical suspicion and confirmation of karyotype. Initial uncertainty and a delay in the diagnosis were detrimental to parental coping, as was premature communication of the news. Perinatal complications increased parental anxiety regarding their child's condition and future. Individual communication style of midwives and physicians was a powerful predictor of parental adaptation. Parental needs for support and information were facilitated through normalising postnatal care, ensuring privacy, and providing early access to peer support and up-to-date written information. Many parents would have appreciated access to a liaison worker. CONCLUSION The experiences of parents in this study provide practice points for improving postnatal care with minimal changes to formal service systems.
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Affiliation(s)
- Evelyne E Muggli
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
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Abstract
BACKGROUND Finding out that your child has cancer is a devastating experience. How this information is communicated can have a lasting impression on parents receiving the news. The purpose of this study was to assess how well parents recall discussing the diagnosis of cancer and to summarize suggestions for improvement. METHODS A questionnaire was developed with input from several parents of children previously diagnosed with cancer. All parents of children <18 years of age with a diagnosis of cancer who were >1 month post-diagnosis at our children's hospital were asked to participate. The patient sample was identified through the in- and outpatient clinics from June to August 2006. RESULTS One-hundred sixteen parents (mothers and fathers) completed the questionnaire, with only two parents refusing (1.7%). The moment of disclosure of the diagnosis was remembered vividly in 77%, well in 20%, and somewhat, vaguely or not at all in 1% each. Parental reaction to the disclosure was viewed as a positive experience 79% of the time and a negative experience 21% of the time. Parents also provided a number of suggestions for future disclosure. CONCLUSIONS The majority of parents recall receiving the diagnosis and the discussions that ensued about their child's diagnosis of cancer. Most parents were satisfied with their experience with receiving the diagnosis. Suggestions for improvement can be incorporated into future educational indicatives for front line healthcare providers to improve communication of sensitive diagnoses with parents.
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Affiliation(s)
- Torrey M Parker
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Levetown M. Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics 2008; 121:e1441-60. [PMID: 18450887 DOI: 10.1542/peds.2008-0565] [Citation(s) in RCA: 279] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.
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Graungaard AH, Skov L. Why do we need a diagnosis? A qualitative study of parents' experiences, coping and needs, when the newborn child is severely disabled. Child Care Health Dev 2007; 33:296-307. [PMID: 17439444 DOI: 10.1111/j.1365-2214.2006.00666.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Communication with parents who are realizing their child is severely disabled is a difficult task for professionals. Parents are experiencing great emotional stress during the diagnostic process and dissatisfaction with disclosure is widespread. The aim of this study was to investigate parents' reactions when realizing their child's disability, the impact of the diagnosis and parents' ways of coping. METHODS This was a qualitative, longitudinal study, using in-depth interviews with 16 parents of a physically and mentally disabled child who had recently been diagnosed as such. Children's age at inclusion ranged from 1 to 27 months. Half of the children had an unknown diagnosis. Data were analysed using the Grounded Theory method. RESULTS were validated and approved by the interviewed parents. RESULTS The certainty of the diagnosis was central for parents' experiences. First, the emotional reaction of the parents is highly influenced by the diagnostic process. Second, parents needed possibilities for taking action, and third they found difficulty in coping with an uncertain future. These three themes all related to the meaning that parents ascribed to the stating of a diagnosis. Parents' needs in relation to communication were identified as equality in co-operation with doctors, an empathic professional approach, and the child being seen with possibilities despite his or her disabilities. CONCLUSIONS Parents' process of realization was related to the diagnostic process, and information and communication should be individualized accordingly. Parents wanted to co-operate and they needed possibilities for active coping with their situation.
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Affiliation(s)
- A H Graungaard
- Department of General Practice, Centre of Health and Society, 5 Øster Farimagsgade, 1014 Copenhagen K, Denmark.
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Elwy AR, Michie S, Marteau TM. Attributions and reported communication of a diagnosis of down syndrome. HEALTH COMMUNICATION 2007; 22:115-21. [PMID: 17668991 DOI: 10.1080/10410230701453975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study investigates attributions and reported communication in 97 neonatologists who responded to a vignette-based questionnaire depicting a woman with 1 of 3 prenatal screening histories for Down syndrome (DS) who had just given birth to a child with DS: not offered screening, refused screening, or received a false negative result on screening. Neonatologists reported blaming and attributing more control to women who refused prenatal screening for DS. Attributions of blame, but not control, were associated with reports of communicating more negative information on DS to parents. Neonatologists may make attributions about women on the basis of their screening histories, which appear to influence some but not all aspects of how they report communicating a diagnosis of DS.
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Affiliation(s)
- A Rani Elwy
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Department of Veterans Affairs, Boston University School of Public Health, Boston, Massachusetts, USA.
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Dent KM, Carey JC. Breaking difficult news in a newborn setting: Down syndrome as a paradigm. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2006; 142C:173-9. [PMID: 17048355 DOI: 10.1002/ajmg.c.30100] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Breaking the difficult news of an unexpected diagnosis to parents in the newborn setting is a common occurrence in genetic counseling. Many clinical geneticists and genetic counselors have had the challenge of delivering a postnatal diagnosis of Down syndrome to parents of newborns. Down syndrome is a common chromosome condition occurring in approximately 1 in 800 live births. Presenting the diagnosis to families must be accomplished in a supportive, positive, caring, and honest manner. However, there are few scientific data and little instruction in training programs on how best to convey this news in an appropriate manner. Several articles in the literature over the last three decades have proposed various guidelines for the so-called informing interview. Discussions of parents' preferences and experiences in receiving this news have also been documented. Few reports, however, have focused on breaking difficult news of the diagnosis of a genetic condition to parents in a newborn setting in the genetics literature. In this paper, we will review the medical literature on delivering difficult news, specifically focused on that regarding the diagnosis of Down syndrome in the newborn setting. We propose a theoretical framework from which the informing interview can be planned and future outcome data can be measured. In this way, researchers of this theme can investigate the process, including the healthcare professionals' delivery of difficult news and make recommendations for continued improvement of the process. Our model can be generalized to breaking difficult news for a variety of other congenital conditions.
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Affiliation(s)
- Karin M Dent
- Congenital Hearing Loss Research Clinic, University of Utah Medical Center, Salt Lake City 84132, USA
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Tattersall H, Young A. Deaf children identified through newborn hearing screening: parents' experiences of the diagnostic process. Child Care Health Dev 2006; 32:33-45. [PMID: 16398789 DOI: 10.1111/j.1365-2214.2006.00596.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As part of the Department of Health funded evaluation of the first phase of the National Health Service Newborn Hearing Screening Programme in England, 45 parents/caregivers whose children were correctly identified as deaf through the screening programme were interviewed about their experiences. METHODS The study took a qualitative descriptive approach and thus sought to privilege parents' unique epistemological position, valuing their accounts as expert knowledge and allowing them to set the criteria for what should be counted as meaningful within their accounts. The sample of 45 parents/caregivers was diverse in terms of ethnicity and socio-economic status. In addition, the children represented a diversity of degrees of deafness and additional needs. Data were analysed using QSR NUD*IST 4. RESULTS The diagnostic period emerged as an important time for parents. This refers to the period of time that follows the referral from screen and starts with the first appointment at audiology for audiological assessment. The diagnostic process was found to be hugely variable for each family, both objectively, e.g. in terms of number of appointments they had to attend, and also attitudinally, e.g. some families perceived this period of time as a series of discrete events while others viewed it as part of a process that had started with the first screening event. Although it is reasonable to expect such factors to be the most influential in accounting for variations in parental satisfaction with the diagnostic process, it was in fact professional communication and manner that emerged as the most significant predictors of their experiences. DISCUSSION The discussion concentrates on the question of whether early identification of deafness and the subsequent compressed time frame of events between birth and diagnosis create "new" experiences for parents or whether in fact the new circumstances surrounding diagnosis make no difference to the way in which professionals approach their encounters with parents.
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Affiliation(s)
- H Tattersall
- School of Nursing, Midwifery and Social Work, The University of Manchester, 4th Floor Williamson Building, Oxford Road, Manchester M13 9PL, UK.
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Abstract
Delivering and receiving a postnatal diagnosis of Down syndrome is not an easy experience for most physicians or parents. In this study, 467 mothers of children with Down syndrome in Spain completed a survey about the postnatal support services they received immediately following the diagnosis of their child. Mothers reported feeling anxious, frightened, guilty, angry, and, in rare cases, suicidal. According to most mothers, physicians did not give adequate amounts of information about Down syndrome and rarely did they give enough printed materials or make referrals to parent support groups. Little seems to have changed since 1972. Mothers provided recommendations on how the Spanish medical system could be improved, with implications for other countries including the United States.
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Affiliation(s)
- Brian Skotko
- Harvard Medical School, 12 Greenway Ct., Suite 5, Brookline, MA 02446, USA.
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Abstract
This review explores social science analyses of diagnosis of childhood neurological disabilities. The paper moves through three sections, which capture the historical and conceptual trends within the literature. The first focuses on work identifying the need to communicate effectively with parents when giving a diagnosis, the second explores the role parents can play as "partners" or contributors to diagnosis, and the final section goes further in exploring the social complexity of diagnoses in order to examine the embedded nature of social practices, power relations and hierarchies, and institutions in the diagnosis encounter.
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Affiliation(s)
- J McLaughlin
- School of Geography, Politics and Sociology, 5th Floor, Claremont Bridge Building, University of Newcastle, Newcastle upon Tyne NE1 7RU, UK.
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Abstract
OBJECTIVE Since 1964, researchers have been examining the ways in which physicians deliver a postnatal diagnosis of Down syndrome (DS). Almost all of the studies, however, have been limited to reflections or very small sample sizes. The objective of this study was to document, in the most robust comprehensive way, the reflections of mothers in the United States who received diagnoses of DS for their children. METHODS An 11-page survey was mailed to 2945 persons on the membership lists of 5 DS parent organizations. The survey gathered both quantitative and qualitative data with yes/no questions, open-ended questions, and a series of statements asking the mothers to rate their level of agreement on a Likert scale of 1 to 7. RESULTS Of the 1250 responses (42.4%), 985 were from mothers who received postnatal diagnoses of DS for their children. The majority of these mothers reported being frightened or anxious after learning the diagnosis, and very few rated the overall experience as a positive one. Mothers reported that their physicians talked little about the positive aspects of DS and rarely provided enough up-to-date printed materials or telephone numbers of other parents with children with DS. Improvement has been made with time, albeit slowly. CONCLUSION Mothers have called on physicians to improve the way in which postnatal diagnoses are delivered. Specific recommendations are offered.
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Hill V, Sahhar M, Aitken M, Savarirayan R, Metcalfe S. Experiences at the time of diagnosis of parents who have a child with a bone dysplasia resulting in short stature. Am J Med Genet A 2003; 122A:100-7. [PMID: 12955760 DOI: 10.1002/ajmg.a.20201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many studies have shown that, for families who are given the diagnosis of a disability, satisfaction with disclosure is an important element. Information given and the attitudes of the disclosing health professionals during this critical period have a significant effect on the coping and adaptation of the family. While most studies dealt with conditions involving intellectual disability or cancer, this study was conducted to explore parents' experience of being told that their child had a condition, such as a bone dysplasia, that would result in significant short stature. Semistructured interviews were conducted with 11 families who had children diagnosed with a bone dysplasia, specifically, achondroplasia (n = 9) and pseudoachondroplasia (n = 2). Families were recruited through the Bone Dysplasia Clinic at the Royal Children's Hospital, Victoria, Australia and via contact with the Short Statured People's Association of Victoria. Parents were asked about how they were told of their child's diagnosis, how they would have preferred to have been told, and what would have made the experience less distressing for them. Transcripts of the interviews were analyzed, and major themes were identified relating to the parents' experiences. Our data suggest that the manner in which the diagnosis is conveyed to the parents plays a significant role in their adjustment and acceptance. Provision of written information relating to the condition, possible medical complications, positive outlook for their child's future, and how to find social services and supports were some of the most significant issues for the parents. The multidisciplinary approach of the Bone Dysplasia Clinic was important to parents in the continued management of the families.
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Affiliation(s)
- Victoria Hill
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Bellew M, Kay SP. Early parental experiences of obstetric brachial plexus palsy. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2003; 28:339-46. [PMID: 12849945 DOI: 10.1016/s0266-7681(03)00081-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Early parental experiences of having a child with obstetric brachial plexus palsy were examined to determine whether there were any areas of dissatisfaction and, if so, whether these resulted from their distress and a need to blame someone, or from problems in the communication of bad news. A high level of dissatisfaction was reported with similar levels of dissatisfaction found in a mildly injured group that did not require surgery, and a severely injured group that did. This suggests either that degree of dissatisfaction is not related to degree of disability, or that dissatisfaction was due to factors other than a reaction to their child having a problem. Support was found for the latter as the parents reported details of problems in communication, particularly the giving of inaccurate and misleading information.
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Affiliation(s)
- M Bellew
- Department of Plastic Surgery, St James's University Hospital, Leeds, UK.
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Byrnes AL, Berk NW, Cooper ME, Marazita ML. Parental evaluation of informing interviews for cleft lip and/or palate. Pediatrics 2003; 112:308-13. [PMID: 12897279 DOI: 10.1542/peds.112.2.308] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was conducted to record subjective information concerning parental experiences and preferences with regard to informing interviews for cleft lip and/or palate. The analysis of these data was intended to help informants improve the way in which such conversations are conducted. METHODS The study used a self-administered questionnaire. Study participants were the biological parents of children who had cleft lip and/or palate and were seen in the University of Pittsburgh Cleft Palate-Craniofacial Center. RESULTS Results revealed that parents wanted informing health professionals to be in greater control of the informing conversation, to show more caring and confidence, to show more of their own feelings, to give parents more of an opportunity to talk and show feelings, to make a greater effort to comfort parents, to provide more information, to initiate more of a discussion about the association between clefts and mental retardation/learning disabilities, and to provide more referrals to other parents during the informing interview. A positive association between the degree to which parents reported knowing the health professionals and reported satisfaction was identified for 10 dimensions of health professional behavior. CONCLUSIONS Parents are dissatisfied with several aspects of informing interviews for cleft lip and/or palate. The results of this study suggest ways to improve informing interviews for oral-facial clefts and other congenital anomalies.
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Affiliation(s)
- Abigail L Byrnes
- Department of Genetics, Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- G Latini
- Perrino Hospital Division of Pediatrics, Clinical Physiology Institute, Lecce Section, National Research Council of Italy, Brindisi, Italy.
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Hedov G, Wikblad K, Annerén G. First information and support provided to parents of children with Down syndrome in Sweden: clinical goals and parental experiences. Acta Paediatr 2003; 91:1344-9. [PMID: 12578293 DOI: 10.1111/j.1651-2227.2002.tb02832.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992-1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy-five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better. CONCLUSION The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable.
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Affiliation(s)
- G Hedov
- Unit of Paediatrics, Department of Women's and Children's Health, Uppsala University, Sweden
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32
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Taanila A. Well-presented first information supports parents' ability to cope with a chronically ill or disabled child. Acta Paediatr 2003; 91:1289-91. [PMID: 12578281 DOI: 10.1111/j.1651-2227.2002.tb02820.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Taanila
- Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland.
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33
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Affiliation(s)
- Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada L8S 1C7.
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Brogan CA, Knussen C. The disclosure of a diagnosis of an autistic spectrum disorder: determinants of satisfaction in a sample of Scottish parents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2003; 7:31-46. [PMID: 12638763 DOI: 10.1177/1362361303007001004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Satisfaction with disclosure of the diagnosis of an autistic spectrum disorder was investigated using a self-report questionnaire completed by 126 parents. On a rating of satisfaction, 55 percent indicated that they were satisfied or very satisfied with the disclosure. Parents were more likely to be satisfied if they gave positive ratings to the manner of the professional and the quality of the information provided; if they had been given written information and the opportunity to ask questions; and if their early suspicions had been accepted by professionals. These factors were combined into a global index of satisfaction; those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement. These results underline the importance of the interaction between parent and professional during the disclosure interview.
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Affiliation(s)
- Clare A Brogan
- Department of Psychology, Glasgow Caledonian University, Scotland, UK.
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35
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Cope CD, Lyons AC, Donovan V, Rylance M, Kilby MD. Providing letters and audiotapes to supplement a prenatal diagnostic consultation: effects on later distress and recall. Prenat Diagn 2003; 23:1060-7. [PMID: 14691993 DOI: 10.1002/pd.747] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Information provided at a mid-trimester fetal scan aims to improve patients' knowledge and minimize anxiety. This randomized controlled trial conducted at the Fetal Medicine Centre at Birmingham Women's Hospital aimed to assess the relative value of providing 1.standard information: a consultation and computer-generated ultrasound report (n = 29); 2.standard information plus a post scan written non-technical letter (n = 29); 3.standard information plus audiotapes of the consultation (n = 29); 4.standard information plus both non-technical letters and audiotapes (n = 30). It also aimed at exploring whether severity of diagnosis (none; mild; moderate-severe) interacted with the type of information provided to affect subsequent anxiety, depression and recall of information. PARTICIPANTS Women (n = 550) referred with suspected fetal anomalies (without a previous history of anomaly or known psychiatric illness) were sent information regarding this study. One hundred and seventeen women consented and were randomly assigned to one of four information groups. The groups were similar with regard to age, education and marital status. MAIN OUTCOME MEASURES State anxiety and depression were evaluated with the self-report State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) prior to consultation and two weeks post-scan. A structured telephone interview assessed recall of information approximately two weeks later. RESULTS Two weeks after the initial consultation, women who received an audiotaped recording of the consultation reported significantly less anxiety than the control group (mean STAI 41.44 [95% CI 35.63-47.26] versus 44.92 [39.32-50.52]; difference = 10.70 [3.56-17.83], p < 0.01). Women who received a non-technical letter also reported less anxiety than the control group, an effect that approached significance (mean STAI 39.08 [95% CI 32.85-45.30]; difference = 6.48 [0.21-13.16], p = 0.058). There were no differences between the information groups on depression scores or recall of information. Women with a more severe abnormality reported higher anxiety and depression two weeks post-consultation, and had greater free recall but less cued recall of information. CONCLUSIONS Provision of additional material (particularly an audiotape) following a prenatal scan appears to minimise anxiety compared with standard practice. Provision of audiotapes and non-technical letters do not appear to affect patient recall.
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Affiliation(s)
- C D Cope
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
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37
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Cunningham C, Newton R, Appleton R, Hosking G, Mckinlay I. Epilepsy--giving the diagnosis. A survey of British paediatric neurologists. Seizure 2002; 11:500-11. [PMID: 12464510 DOI: 10.1016/s1059-1311(02)00136-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Adult-centred studies continue to show poor information provision and understanding in people with epilepsy. This study explores whether paediatric neurologists work within a consultation framework designed to meet information needs. A questionnaire on how to give the diagnosis was sent to 32 UK Paediatric Neurologists. Consultation content was largely determined intuitively rather than on a shared knowledge of the process involved. Little consensus was identified in relation to analogy and the usefulness or awareness of available unevaluated literature; but most acknowledged the value of a specialist epilepsy nurse. Most responses were based on a typical medical agenda but less than 20% addressed emotional responses and adaptation. Three approaches were identified-'pro-active' (running the risk of overload but recognising the right of parents to information), 'reactive' (more individually tailored, but assumes doctors can judge parental reactions) and 'drip-feed' (protective and pre-selecting topics to meet the situation). Our aim to establish a guideline proved impossible. Further study should develop more detailed models of the disclosure process, and identify epilepsy explanations that can be consumer-tested.
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Bartolo PA. Communicating a diagnosis of developmental disability to parents: multiprofessional negotiation frameworks. Child Care Health Dev 2002; 28:65-71. [PMID: 11856189 DOI: 10.1046/j.1365-2214.2002.00243.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is a hard task for professionals to give and parents to receive the bad news about a child's developmental disability. This study describes how findings about four preschool children, with difficulties suspected to lie within the autistic spectrum, were negotiated with parents by two multiprofessional groups, one in a Medical (Site M) and one in an Education setting (Site E). Each assessment was undertaken over half a day, the professionals jointly interacting with the child and family. All assessment discussions were audiotaped and each participant was interviewed after the assessment. Conversation analysis showed the activation of three major social-interaction frameworks: professionals at both sites applied a parent-friendly frame, but this was complemented by a hopeful-diagnostic-formulation frame at Site M, and a defocusing-of-bad-news frame at Site E.
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Affiliation(s)
- P A Bartolo
- Department of Psychology, University of Malta, Msida, Malta.
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39
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40
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Abstract
The aim of the paper is to propose guidelines for good practice in disclosing the diagnosis of cerebral palsy to parents. The guidelines draw on an interview study with parents of 107 children, average age 24 months, in the South East Thames region. In addition case notes were examined, and mothers completed questionnaires to measure current levels of depression and coping strategies. Dissatisfaction with how the diagnosis had been disclosed was greater where children had been premature and/or low birth weight, where they developed more severe degrees of physical disability, and where the diagnosis had been made later. Dissatisfaction was related to greater degrees of later self reported depression. The guidelines take account of the findings, in particular the need for early close liaison between neonatology and community paediatric services. Suggestions are made for how to ensure implementation and monitoring of good practice.
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Affiliation(s)
- G Baird
- Guy's and St Thomas's NHS Trust, Newcomen Centre, Guy's Hospital, 1 St Thomas Street, London SE1 9RT, UK.
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41
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Statham H, Solomou W, Chitty L. Prenatal diagnosis of fetal abnormality: psychological effects on women in low-risk pregnancies. Best Pract Res Clin Obstet Gynaecol 2000; 14:731-47. [PMID: 10985942 DOI: 10.1053/beog.2000.0108] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
When given an adverse prenatal diagnosis, parents are deeply shocked and experience acute grief. This review considers the psychological outcomes for parents whether they opt to terminate the pregnancy or continue, either through choice or because termination is not an option. It covers the full spectrum of malformation from treatable, through those carrying a risk of significant handicap, to lethal. It draws on two types of studies: those that are retrospective and qualitative, describing feelings and aspects of care, and those that are prospective and assess psychological state with standardized measures of grief, anxiety and depression. The relationship between psychological outcome and possible associated variables, such as individual characteristics, nature of the abnormality and obstetric factors is described and evaluated. In addition, the authors draw on both scientific and support group literature to summarize good practice for the care of parents receiving an unexpected diagnosis of fetal abnormality.
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Affiliation(s)
- H Statham
- Centre for Family Research, University of Cambridge, Cambridge, CB2 3RF, UK
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42
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Hasnat MJ, Graves P. Disclosure of developmental disability: a study of parent satisfaction and the determinants of satisfaction. J Paediatr Child Health 2000; 36:32-5. [PMID: 10723688 DOI: 10.1046/j.1440-1754.2000.00463.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the level of parent satisfaction with the first communication of a diagnosis of developmental disability in their child ('disclosure') and the determinants of this satisfaction. METHODOLOGY Interviews with parents of children with developmental disabilities regarding their experiences at the time of disclosure and their level of satisfaction with the process were carried out. RESULTS Parent satisfaction with disclosure overall was found to be high (82.6%). Parents were more likely to be satisfied if they received a large amount of information. Parent satisfaction was found to be higher when the disclosing professional communicates well with the parents, has an understanding of parental concerns, and is direct in manner. Having both parents, the child or support people present were not found to have any significant relationship to parent satisfaction. CONCLUSIONS The high level of satisfaction with disclosure in this study supports the claim made by earlier researchers that parental dissatisfaction with the disclosure process is not inevitable. The major determinants of parental satisfaction with disclosure are directness, understanding of parental concerns and good communication on the part of the disclosing professional, and receiving a large amount of information.
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Affiliation(s)
- M J Hasnat
- Department of Paediatrics, Monash University, Monash Medical Centre, Clayton, Victoria, Australia.
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Abstract
OBJECTIVE To investigate paediatricians' practices in disclosure of disability and the influences on their practices, including attitude to people with disabilities. METHODOLOGY Interviews were conducted with 26 paediatricians regarding their disclosure practices and their experience, training, contact with children with significant disabilities and influences on practices. Anonymous self-report questionnaires to the same group of practitioners relating to attitude to disability were also employed. RESULTS Paediatricians' practices in the disclosure process scored relatively low on an index based upon recommended practices. No significant relationships were found between index scores and the experience or training of the paediatrician or the amount of contact of the paediatrician with children with disabilities. However, more experienced paediatricians were found to be more likely to mention the practice of informing both parents together and the presence of a support person at the time of disclosure. Paediatricians having more contact with children with disabilities were more likely to mention that they would disclose disability in a child as soon as possible. The major modifying influences on disclosure practices were reported to be the intelligence of the parents and their emotional state of at the time of disclosure. Time was the most frequently reported constraint upon disclosure practices. CONCLUSIONS The low 'disclosure practice index' scores in this study are not necessarily an indication that practices are poor, as there are challenges to the validity of the advocated practices. There were few significant associations found between the practices of paediatricians in disclosure and their experience, training, contact with children with disabilities and attitude to people with disabilities.
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Affiliation(s)
- M J Hasnat
- Department of Paediatrics, Monash University, Monash Medical Centre, Clayton, Victoria, Australia.
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Abstract
The purpose of this study was twofold: (a) to describe parental perceptions of family-provider relationships, and (b) to explore links between parental perceptions of family-provider relationships and well-being in families with children who have Down syndrome. Mailed questionnaires were used to collect data from 94 families that include a child with Down syndrome. Data from 89 mothers are the focus of this report. The results indicate that when mothers of children with Down syndrome believe that their family's relationship with health care providers is positive and family-centered, they feel more satisfied with the care that their child is receiving and they are more likely to seek help from health care providers. In addition, when a discrepancy exists between what mothers want the family-provider relationship to be and what they believe the relationship is, mothers feel less satisfied with the care that their child is receiving. Finally, higher levels of individual and family well-being are reported by mothers who (a) want, and believe they have, positive family-centered relationships with providers, and (b) feel more satisfied with care received. Results of this study contribute to a better understanding of the role that health care providers play in individual and family adaptation to chronic conditions.
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Affiliation(s)
- M Van Riper
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA
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45
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Abstract
The majority of doctors in North America, Australia and much of Europe now inform patients about a cancer diagnosis. However, many doctors report that they have difficulty disclosing a cancer diagnosis. Poor doctor-patient communication skills may lead to psychological distress including increased anxiety and depression and poorer psychological adjustment to cancer. Presenting 'bad' news in an unhurried, honest, balanced and empathic fashion has been shown to produce greater satisfaction with communication of the news. Consensus guidelines have been developed to assist doctors to disclose a cancer diagnosis. Important aspects include exploring the patient's expectations, warning him/her that the news is bad, giving the news at the patient's own pace, allowing time for the patient to react and eliciting the patient's concerns. Doctor-patient communication can be improved by including training courses in communication skills for medical students and clinicians and providing audiotapes of bad news consultations to enhance patient recall of information and increase patient satisfaction with communication. Additional research is needed to investigate effects of strategies to implement guidelines for delivering a cancer diagnosis.
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Affiliation(s)
- P M Ellis
- Medical Psychology Unit, University of Sydney, NSW, Australia
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46
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Cuttini M, Rebagliato M, Bortoli P, Hansen G, de Leeuw R, Lenoir S, Persson J, Reid M, Schroell M, de Vonderweid U, Kaminski M, Lenard H, Orzalesi M, Saracci R. Parental visiting, communication, and participation in ethical decisions: a comparison of neonatal unit policies in Europe. Arch Dis Child Fetal Neonatal Ed 1999; 81:F84-91. [PMID: 10448174 PMCID: PMC1720990 DOI: 10.1136/fn.81.2.f84] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To compare neonatal intensive care unit policies towards parents' visiting, information, and participation in ethical decisions across eight European countries. METHODS One hundred and twenty three units, selected by random or exhaustive sampling, were recruited, with an overall response rate of 87%. RESULTS Proportions of units allowing unrestricted parental visiting ranged from 11% in Spain to 100% in Great Britain, Luxembourg and Sweden, and those explicitly involving parents in decisions from 19% in Italy to 89% in Great Britain. Policies concerning information also varied. CONCLUSIONS These variations cannot be explained by differences in unit characteristics, such as level, size, and availability of resources. As the importance of parental participation in the care of their babies is increasingly being recognised, these findings have implications for neonatal intensive care organisation and policy.
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Affiliation(s)
- M Cuttini
- Unit of Epidemiology and Unit of Neonatal Intensive Care, Burlo Garofolo Children's Hospital, Trieste, Italy.
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47
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Cooley WC. Responding to the developmental consequences of genetic conditions: The importance of pediatric primary care. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990625)89:2<75::aid-ajmg4>3.0.co;2-k] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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48
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Abstract
One of the consequences of genetic impairments in early childhood is their long-term effect on children's developmental skills in communication, learning, and adaptive behaviors. Functional assessment provides families and clinicians with a common language for describing a child's strengths and limitations in self-care (feeding, dressing, grooming, bathing, continence), mobility, and communication/social cognition. The National Center for Medical Rehabilitation Research described a model of disablement that includes five dimensions: pathophysiology, impairment, functional limitations, disability, and societal limitations. Using this framework, along with the Functional Independence Measure for children, the WeeFIM(R), we describe functional strengths and challenges in children with Down syndrome, spina bifida, congenital limb anomalies, congenital heart disease, urea cycle disorders, severe multiple developmental disabilities, and DiGeorge malformation sequence. We also briefly describe several pediatric functional/adaptive assessment instruments used by developmental professionals (Battelle Developmental Inventory, Vineland Adaptive Behavior Scales, Amount of Assistance Questionnaire). By tracking functional status, health professionals can prioritize secondary and tertiary prevention strategies that optimize self-care, mobility, communication, and learning. When functional limitations interfere with the acquisition of these essential skills, family and community support programs can be maximized.
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Affiliation(s)
- M E Msall
- Child Development Center, Rhode Island Hospital, APC-6, 593 Eddy St.,
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49
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Abstract
OBJECTIVE To explore the perspective of parents with regard to disclosure of disability and early follow-up care. DESIGN The research approach was hermeneutic phenomenology. Data were collected using focused interviews that were audio-taped, transcribed and interpreted. SETTING Scotland. PARTICIPANTS The parents of 63 children born with a congenital limb deficiency. FINDINGS The findings demonstrate the complexity and variability in parental response. Additionally, what is shown is that disclosure was often handled poorly and that the support offered during the stay in the maternity unit was frequently inadequate. CONCLUSION In order to handle disclosure effectively, health professionals require appropriate education and training and it is recommended that innovative ways of encouraging discussion and debate are sought.
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Affiliation(s)
- S M Kerr
- Department of Nursing and Midwifery Studies, University of Glasgow, UK.
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50
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Taanila A, Järvelin MR, Kokkonen J. Parental guidance and counselling by doctors and nursing staff: parents' views of initial information and advice for families with disabled children. J Clin Nurs 1998; 7:505-11. [PMID: 10222945 DOI: 10.1046/j.1365-2702.1998.00190.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper describes changes that have taken place, over a period of 10 years, in the way physicians and nursing staff in Finland give initial information and advice to the parents about their child's disability. It also discusses the association between quality of information given and parents' feelings of insecurity or helplessness. In the study, we compared the experiences of parents of older (aged 12-17) disabled children with those of parents with younger (aged 7-9 years) disabled children. There were 85 children, whose disabilities were either learning or physical, or, in a few cases, both. Parents completed a questionnaire and were interviewed by a social worker. According to these reports, the initial information and advice received by the parents with younger children about their child's disability and its treatment, and on coping with the child at home, was better than that received by the parents of the older children. The parents of the younger children also reported feeling better prepared to take care of their child. Those parents who reported having received little information and practical advice on coping with their child at home experienced feelings of insecurity and helplessness five times as often as those who were satisfied with the information and advice.
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Affiliation(s)
- A Taanila
- Department of Public Health Science, University of Oulu, Finland
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