235 Breaking bad news

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					       2.3.5 Explaining to a woman that her baby has a possible

       Breaking bad news: some suggested strategies

       It is never easy to give a woman the news that there is, or may be something wrong with
       her baby. As a sonographer you have limited time to build a rapport with her and it is likely
       that the possibility of an abnormality being present is far from her mind, despite the
       information she will have been given about the purposes of the scan.

       Each health professional will develop different strategies for handling how to communicate
       difficult and, possibly uncertain, news to a woman.

       Some issues to think about in advance

       You may find it helpful to consider some of the following:
       • is the diagnosis clear-cut or very complex?
       • try to gauge what is the best way of telling this particular woman and rehearse it
          before disclosing – this is intuitive and will change with every individual
       • think about previous similar experiences and knowledge of the condition and use this
          to inform your approach to breaking bad news
       • before breaking the news, ascertain as best you can if you are dealing with an
          isolated abnormality or multiple abnormalities – it may be necessary to complete the
          whole examination before offering an outcome
       • give yourself time to think and don’t be tempted to begin offering information until you
          have formulated what you are going to say - just keep scanning until you are ready
       • is there a ‘safety net’ of a midwife/obstetrician available immediately to discuss
          possible options?
       • Is there a suitable quiet room nearby where you can take the woman if she needs
          time and space to take in the news?
       • when may the next fetal medicine referral be available (if appropriate)?
       • think about how to word the report to be sure it mirrors the verbal explanation you
          have given to the woman, and to the midwife who may spend time with the woman
          immediately afterwards.

       Some possible strategies

       You can develop your ability to communicate bad news to a woman by observing a
       number of principles:
       • develop an initial rapport by paying careful attention to introductions – this includes
          asking the name of the person accompanying the woman
       • be aware of the woman’s obstetric history to give context – especially if a previous
          pregnancy was difficult or if she has suffered a loss and bereavement. Acknowledge
          any losses so she is aware she will be treated with sensitivity and patience if she
          appears anxious                   January 2010
       •   try not to let your facial expressions and body language betray the fact that you have
           seen an abnormality until you are ready to discuss what you have found
       •   deal as best you can with any children with her – you may want to ask them to leave
           the room whilst you discuss the results of the scan
       •   make sure the woman is comfortable, for example, wipe the gel off her abdomen, turn
           on a suitable light and allow her to sit up so that she is in a less vulnerable position
           when you give her the bad news
       •   use body language and changes in your tone of voice to indicate that you are about to
           give bad news
       •   give the information in as clear, unambiguous and sympathetic a manner as possible,
           in manageable chunks and check the woman has understood. Don’t use euphemisms
           or medical terminology unless you are prepared to explain it
       •   be honest! If you don’t know what this may mean for her baby's prognosis, then say
       •   offer to show the woman the images on the ‘saved’ still images or in real-time to help
           her understand your explanations
       •   offer immediate options for the next steps, e.g.
                have a cup of tea and some privacy to take in the news
                talk to a midwife, another sonographer or obstetrician
                go home and return the following day
                wait for a referral to see a specialist
       •   write a report that the woman can understand.
       •   If possible, give the woman written information about the abnormality that she can
           understand an take away with her
       •   provide her with information about charities and support groups such as Antenatal
           Results and Choices (ARC), Cleft Lip and Palate Association (CLAPA), Still Birth and
           Neonatal Death (SANDS) and the British Heart Foundation (BHF)
       •   if the woman has no adult accompanying her at the scan, help her contact someone
           supportive to collect her.

       Finally: be flexible and be prepared to adjust your approach depending on how the
       woman responds.                  January 2010

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