COMMUNICATION DURING THE ANTENATAL CONSULTATION FOR ANTICIPATED BIRTH OF AN EXTREMELY PREMATURE INFANT: A SYSTEMATIC REVIEW

Abstract

BACKGROUND: Parental distress associated with anticipated delivery of an extremely preterm infant necessitates tactful communication by healthcare professionals. The antenatal consultation (ANC) to facilitate decision-making is filled with parental fear, anxiety, and questions regarding the future of their child. OBJECTIVES: We performed a systematic review of the literature to synthesize parental expectations on how healthcare professionals should interact with them during an ANC. DESIGN/METHODS: Electronic searches of Medline, CINAHL, PsycInfo, Embase and grey literature were conducted. We included studies that explore parent perspectives and experiences with the ANC. Two independent reviewers reviewed 526 titles, of which 103 abstracts then 25 full text articles were reviewed. Fourteen articles were included for final data abstraction. We pre-determined six topics of interest (setting, timing, preferred healthcare professional, information, resources or aids, parents-physician interaction) to facilitate thematic analysis. Quality appraisal was conducted using Walsh and Downe's guide. RESULTS: In addition to the six pre-determined topics of interest, overarching themes such as perception of support, degree of understanding, hope, spirituality and faith and decision-making emerged from the review. Studies suggest the quality of the ANC is not purely about information content, but also the manner in which that information is provided and how the healthcare provider builds trust. There is no 'one-size-fits-all' standard; the evidence indicates that parents may want different information in different ways with variation in physician and nursing roles. Finally, the ANC is not a one-time event; studies suggest parents want multiple opportunities for information gathering and discussion. CONCLUSION: These findings will help guide communication during the ANC in a way that should increase parental engagement and satisfaction. The results were used to generate proposed strategies to facilitate communication that may inform clinical practice guidelines.