Talking to the parents of a baby who is likely to develop permanent neurological impairment following a brain insult in the perinatal period

The use of standardized patients in pediatric residency training in palliative care: anatomy of a standardized patient case scenario

The use of standardized patients (SPs) is an emerging strategy in palliative care education. We have used this strategy to provide pediatric residents with a structured educational experience focused on effectively communicating bad news and concurrently understanding the emotions that they and the parents may experience. This article describes the importance of and process for realistic SP case development explicitly designed to address predetermined educational goals and objectives. Topics addressed include the types of potential SPs that can be utilized, their potential strengths and weaknesses, training issues which include giving constructive feedback, implementation strategies for the case scenarios and evaluation strategies.

Disclosure of developmental disability: a study of paediatricians' practices

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.

Telling parents their child has severe congenital anomalies

A large number of potential malformations exist, but the key skills in communicating with the parents of a malformed baby are the same. Dissatisfaction is common in this situation and has prompted a national initiative in improving standards of disclosure of disability and malformation--the Right from the start strategy (see appendix). Key skills include keeping the family together, ie, not removing the baby unnecessarily, knowing how parents like to be informed, listening, checking that parents have understood, being nonderogatory and, most importantly, emphasizing the positive side of their newborn child.