Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors

J Perinatol. 2017 Nov;37(11):1224-1229. doi: 10.1038/jp.2017.118. Epub 2017 Jul 27.


Objective: Delivering prognostic information to families requires clinicians to forecast an infant's illness course and future. We lack robust empirical data about how prognosis is shared and how that affects clinician-family concordance regarding infant outcomes.

Study design: Prospective audiorecording of neonatal intensive care unit family conferences, immediately followed by parent/clinician surveys. Existing qualitative analysis frameworks were applied.

Results: We analyzed 19 conferences. Most prognostic discussion targeted predicted infant functional needs, for example, medications or feeding. There was little discussion of how infant prognosis would affect infant/family quality of life. Prognostic framing was typically optimistic. Most parents left the conference believing their infant's prognosis to be more optimistic than did clinicians.

Conclusions: Clinician approach to prognostic disclosure in these audiotaped family conferences tended to be broad and optimistic, without detail regarding implications of infant health for infant/family quality of life. Families and clinicians left these conversations with little consensus about infant prognosis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Communication
  • Counseling / standards
  • Critical Illness / psychology
  • Critical Illness / therapy
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Parents / psychology*
  • Perception
  • Professional-Family Relations*
  • Prognosis*
  • Qualitative Research
  • Quality of Life
  • Truth Disclosure*
  • Video Recording