503 - Barriers to Serious News Communication with Parents in the NICU: A Qualitative Study of Interprofessional Clinicians in Ethiopia and Ghana

Poster Number: 503
Publication Number: 503.572

Background: In low- and middle-income countries (LMICs), resource limitations restrict the neonatal clinicians’ ability to diagnose and support seriously ill infants, leading to higher neonatal mortality. Communication challenges between parents and clinicians are common and problematic in these situations.

Objective: We sought to characterize clinician perspectives on barriers to communicating with parents of critically ill infants, including information about an infant’s condition, diagnosis, prognosis, and care plan, in the neonatal intensive care unit (NICU).

Design/Methods: We conducted qualitative interviews in sub-Saharan Africa (Ethiopia and Ghana). A purposive sample of senior physicians, physicians in training, nurses, and midwives at three participating study sites with NICUs were interviewed (n=40). The approach was guided by the consolidated criteria for reporting qualitative research; interviews were coded through the constant comparative method of theme generation. Transcripts were coded by three team members with discrepancies resolved via discussion.

Results: Demographics of interview participants are in Table 1. All clinicians felt it was their duty to inform parents about an infants’ serious prognosis and provide them education around the condition and its implications. However, they reflected that several barriers impeded communication; Ethiopian and Ghanian clinicians described similar barriers. Major themes included: 1) Resource Barriers (Table 2A, sub themes: imaging and laboratory constraints, insufficient time and personnel, large number of patients, overcrowded physical space, lack of parent accommodations); 2) Cultural/Demographic Barriers (Table 2B, subthemes: language barriers, gaps in education and health literacy, and culturally rooted health beliefs); and 3) Social-Emotional Barriers (Table 2C, subthemes: causing emotional trauma, fear of parents’ reactions, damaging trust). They noted more concerns around discussing serious news with the mother than with other family members due to concerns about the mother’s emotional state (Table 3).

Conclusion(s): Clinicians revealed that resource, cultural/demographic, and social/emotional barriers create obstacles when trying to deliver important medical information and prognosis effectively. These barriers contribute to delayed sharing of information, miscommunication, and misunderstanding, and made them reluctant to engage in conversations addressing serious news with families. More research is needed to develop culturally appropriate supports and education for clinicians communicating serious news in global settings.