ORIGINAL ARTICLE

Characterising doctor-parent communication in counselling for impending preterm delivery

J A F Zupancic¹, H Kirpalani², J Barrett³, S Stewart⁴, A Gafni⁵, D Streiner⁶, M L Beecroft⁷, P Smith⁷

¹ Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
² Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
³ Department of Nursing, McMaster University
⁴ Centre for Community Health and Health Evaluation Research, British Columbia’s Children’s Hospital, Vancouver, British Columbia, Canada
⁵ Department of Clinical Epidemiology and Biostatistics, McMaster University
⁶ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
⁷ Department of Obstetrics and Gynecology, McMaster University

Correspondence to:
Correspondence to:
Dr Kirpalani, Department of Pediatrics, McMaster Health Sciences Centre, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8S 4J9;
kirpalan{at}fhs.csu.mcmaster.ca

Objective: To examine the counselling of women admitted to hospital in preterm labour. Such women and their partners are often asked to participate in difficult decisions including mode of delivery, fetal monitoring, and resuscitation.

Study design: Questionnaire based descriptive study.

Study setting: A tertiary level perinatal referral centre.

Patients: Forty nine women in preterm labour at 22–30 weeks gestation, admitted in two separate periods between March 1997 and May 1999.

Intervention and outcome measure: Within 24 hours of counselling, parents were asked to complete a questionnaire assessing recall of the management plan, desire for involvement in decision making, anxiety, and feelings of control over their health. A parallel questionnaire was completed by the clinicians.

Results: Parents and clinicians on recall agreed well about obstetric issues but poorly about neonatal issues. Overall 27% of parents felt: "I would prefer to have the doctors advise me, rather than asking me to decide". In 79% of cases, clinicians believed parents preferred advice rather than to make decisions, but in 45% of these, they misidentified those who wished to make their decisions. Anxiety levels for one third of the mothers were high, and associated with poorer concordance of recall between parents and clinicians.

Conclusions: Serious deficiencies exist in parent-clinician encounters during extremely preterm labour. Concordance between parents and clinicians is poor and anxiety very high. A quarter of parents appear to prefer to relinquish decision making autonomy, but clinicians cannot correctly identify this subgroup. Standardised counselling in the perinatal period, using formal decision aids, should be investigated.

Keywords: ethics; informed consent; preterm delivery; counselling

Abbreviations: STAI, state-trait anxiety inventory; MHLC, multidimensional health locus of control

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