Überbringen schlechter Nachrichten in der Neonatologie Breaking Bad News in Neonatology

The dissertation deals with the breaking of bad news in the context of neonatology. In medicine, breaking bad news refers to negative information regarding diagnosis, treatment and prognosis. This information is given in medical consultations. Based on a systematic literature search, this study investigated the views of neonatologists and affected parents of sick premature and newborn infants on breaking bad news. The admission of a premature or sick newborn to a neonatal intensive care unit (NICU) is an exceptional situation for parents, with feelings of fear, helplessness and loss of control (Al Maghaireh et al., 2016; Gateau et al., 2021; Schecter et al., 2020). Worldwide, around one in 16 newborns is temporarily admitted to a NICU (Haidari et al., 2021). In Germany, around 13% of all newborns spent some time in a NICU in 2021 (Federal Quality Report 2022 Perinatal Medicine, Institute for Quality and Transparency in Healthcare, 2022; Federal Statistical Office, 2023). Studies generally show that communication between physicians and patients/relatives influences their psychological well-being and can trigger stress and negative emotions (experimental control studies (Schmid Mast et al., 2005; Zwingmann et al., 2017), meta-analysis (Schnur et al., 2008)). In neonatology, communication also influences parental coping (review; Labrie et al., 2021), stress experience (Orzalesi & Aite, 2011) or self-management (review; Wreesmann et al., 2021). Delivering bad news leads to stress for both the messenger and the recipient, which is why recommendations for conversation are helpful. One of the most commonly taught recommendations is Baile's SPIKES protocol (Setting, Perception, Invitation, Knowledge, Emotion, Strategy & Summary; Baile et al., 2000). However, the literature on breaking bad news comes predominantly from oncology, with primarily expert-generated recommendations on patient-centered breaking of bad news (Baile et al., 2000; Witt & Jankowska, 2018). In neonatology, there are few studies on the principles, recommendations and effects of breaking bad news (e.g. Bernstein & Lemmon, 2021; Boss et al, 2017; Marçola et al, 2020; Strauss et al, 1995). Therefore, a qualitative content analysis (Mayring, 2015) of expert opinions (senior/chief neonatologists) was conducted and important determinants for the successful delivery of bad news were generated (Seifart et al., 2022): The conceptual framework NEO-SPEAK (Neonatal Prognostic Uncertainty, Encounter, Organization and Teamwork - Situational Stress, Processuality, Emotional Stress, Attention to Individuality, Knowledge and Experience) identifies important components for successful delivery of bad news in neonatology from an expert perspective (ibid., 2022). Parents' views were assessed using a prospective cross-sectional quantitative questionnaire study, comparing parental preferences for breaking bad news with their actual experiences and recording the quality of the conversation (Wege et al., 2023a). In addition, it was investigated whether the mental health of parents and their relationship with physicians differed depending on their level of education in the context of breaking bad news (Wege et al., 2023b). The questionnaire designed for the parent survey was based on the individual SPIKES components and the previous expert and parent interviews (Wege et al., 2023a). The majority of parental preferences for the delivery of bad news differed significantly from their reported experiences with delivery of bad news. The quality of the conversation, in terms of satisfaction, correlated most strongly with a compassionate way of disclosure and an understandable explanation of the infant’s illness (Wege et al., 2023a). Parents with a lower level of education reported significantly less trust in the physicians and a lower sense of security due to the conversation in which bad news was delivered than parents with a higher level of education. Both groups reported high levels of exhaustion and helplessness compared to the norm group. Depressiveness and anxiety were higher in both groups compared to the general population. For all parents, the opportunity to ask questions correlated highly with orientation and security provided by the interview. For all parents, the opportunity to ask questions correlated highly with the orientation and security conveyed by the interview. Only among less educated parents did the feeling of security correlate highly with the hope conveyed during the consultation (Wege et al., 2023b). In addition to providing information, physicians should therefore also make sure to convey hope.