Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences

Expectant parents report negative experiences of receiving unexpected news via ultrasound. There is a need to improve communication in this setting, but a lack of understanding on how to achieve this. This systematic review aimed to synthesise findings from qualitative studies exploring experiences of expectant parents or healthcare professionals when a fetal abnormality or unexpected finding was identified via ultrasound. MEDLINE, EMBASE, CINAHL and PsycINFO were searched using three blocks of terms (fetal abnormalities; ultrasound; experiences). Qualitative studies exploring the disclosure of pregnancy complications during ultrasound examinations were included and analysed using meta‐ethnographic synthesis. The review was conducted according to PRISMA and eMERGe guidelines. The review identified 28 studies. News delivered via ultrasound can be viewed as a journey involving five phases (expectations of ultrasound scans; discovery; shock; decisions and planning; adaptation). How well this is navigated depends upon the extent to which information needs and support needs are met. Ultrasound is a uniquely challenging situation to communicate difficult news as there is the potential for news to be communicated immediately. Care quality could be improved by the provision of written information and the use of correct terminology to describe abnormalities

Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study

Introduction: Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders’ views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers. Methods: Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years). Results: Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques. Conclusions: Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary

Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study

Introduction: Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders’ views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers. Methods: Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years). Results: Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques. Conclusions: Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary

The accuracy of ultrasound estimation of fetal weight in comparison to birth weight: A systematic review

Ultrasound estimation of fetal weight is a highly influential factor in antenatal management, guiding both the timing and mode of delivery of a pregnancy. Although substantial research has investigated the most accurate ultrasound formula for calculating estimated fetal weight, current evidence indicates significant error levels. The aim of this systematic review was to identify the most accurate method, whilst identifying sources of inaccuracy in order to facilitate recommendations for future practice. Seven studies met the inclusion criteria and 11 different formulae were assessed; ultrasound calculation of fetal weight was most commonly overestimated. The Hadlock A formula produced the most accurate results, with the lowest levels of random error. Methods incorporating just two measurement parameters were inconsistent, producing large random errors across multiple studies. Key sources of inaccuracy included difficulties obtaining accurate fetal measurements in late gestation; the remainder were operator dependent, including lack of experience and insufficient training and audit. The accuracy of ultrasound estimated fetal weight has improved in the last decade, though a lack of consistency remains evident. National implementation of a rigorous audit programme would likely improve accuracy further, and increase the confidence and clinical value of the method

Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery

Introduction Ultrasound is used to diagnose pregnancy complications such as miscarriage and fetal health conditions. Within the UK, findings identified during ultrasound examination are delivered by sonographers as standard. However, little is known about the experiences of sonographers when delivering unexpected news (DUN), the impact this has on them, or their preferences for training on news delivery. Methods Qualitative interviews were completed with fourteen sonographers and were analysed using an inductive thematic approach. Key themes were identified. Results Participants said that obstetric ultrasound often involves ‘managing’ the patient encounter, including: navigating (unrealistic) patient expectations; handling their own responses to unexpected findings; and managing interaction by moderating emotional expression and communication practices to deliver patient-centred and empathic care. Persistent uncertainty of outcomes, prognosis and patient reactions, alongside high workloads, and frequent siloed working, makes DUN challenging for sonographers. DUN was experienced as emotionally burdensome, and sonographers employed personal coping strategies to reduce stress/burnout. However, the greatest mitigation for stress/burnout was support from peers, though accessing this was challenging. Peers were also described as key sources of learning, especially through observation. Conclusion Challenges associated with DUN are an enduring experience for sonographers. Facilitating regular ongoing support and training would enable sonographers to cope with negative aspect of the role, including the emotional burden of DUN. Implications for practice Long patient lists are prioritised to deal with high demand for services. However, sonographer wellbeing needs to be a key priority to avoid stress and burnout. This means facilitating protected time to access support from colleagues, multidisciplinary working where possible, and regular access to training to support DUN. Training focusing on communication practices, alongside dealing with emotional burdens of the role would be beneficial

Learning how to deliver bad and challenging news: Exploring the experience of trainee sonographers – A qualitative study

Background: Previous studies suggest there is a need to improve the delivery of bad and challenging news in obstetric ultrasound settings. However, no research has explored the experiences of trainee sonographers when learning how to deliver challenging news. Understanding this could identify gaps in current provision and inform future training interventions. Aims: To explore the experiences of trainee sonographers when learning how to deliver challenging news. Methods: Semi-structured interviews were conducted with trainee sonographers (n = 7) from four training centres to explore their experiences and preferences for news delivery training. Results: Learning how to deliver difficult news was a journey where trainees developed their confidence over time. Most learning occurred in clinical settings, but classroom teaching complemented this. Trainees appreciated the opportunity to observe clinical practice and to hear from patient representatives. However, quality of teaching varied between centres and trainees reported uncertainty regarding the specific language and behaviours they should use. They described building their own personal protocol for news delivery through the course of their training. Discussion: An ultrasound-specific news delivery protocol which details the words and behaviours sonographers can employ could help reduce uncertainty in trainees. Trainees may also benefit from receiving structured feedback on their news delivery performance

Comparison of six commonly used QT correction models and their parameter estimation methods.

This paper compares six commonly used QT correction models and three available parameter estimation methods using five indices for QTc evaluation based on real and simulated electrocardiograph (ECG) datasets. The results show that the golden section approach always finds the correction factor making QTc interval uncorrelated to heart rate for all six formulas. However, the correction formulas derived from mixed model sometimes fail to make QTc interval invariant of heart rate. The performance of an individual least-square regression method lies between the golden section iteration approach and the mixed model in terms of QTc-RR relationship

Narrowly Dispersed, Degradable, and Scalable Poly(oligoethylene glycol methacrylate)-Based Nanogels via Thermal Self-Assembly

Covalently cross-linked and hydrolytically degradable poly­(oligoethylene glycol methacrylate) (POEGMA)-based nanogels are fabricated using an all-aqueous self-assembly approach. The nanogels are composed of hydrazide- (POH) and aldehyde-functionalized (POA) POEGMA precursor polymers that exhibit lower critical solution temperature (LCST) behavior in aqueous media and form a covalent, yet degradable, hydrazone linkage upon mixing. By systematically changing the chemistry of the core and cross-linking precursor polymers, the concentration of the core precursor polymer, the ratio of core to cross-linking precursor polymer, and the temperature at which the assembly is conducted, a library of nanogels was produced with significant differences in size, polydispersity, and colloidal stability. Multivariate statistics indicates the presence of significant nonlinear responses within the process variables as well as correlations between the output variables, reflective of the complex balance of aggregation and stabilization mechanisms at play to produce a stable, monodisperse nanogel population. Furthermore, formulations that yield more polydisperse nanogels on a small scale result in macroscopic aggregate formation when scaled up while formulations that yield more monodisperse nanogels can be scaled to yield nanogels with matched properties. We anticipate these results can be applied to strategically synthesize stable, covalently cross-linked, degradable nanogels with targeted sizes at scalable quantities for a range of biomedical and biosensing applications

Communication coaching for sonographers (CCS): Preliminary evaluation of a novel intervention to improve unexpected news delivery

Objective Obstetric ultrasound scans provide real-time results. In some organisations and countries, the immediate communication of results by sonographers to patients is standard practice, but there is a lack of evidence-based training to support them with this challenging task. This pilot study evaluated a novel communication coaching intervention to improve sonographer communication. Methods Coaches met with sonographers(N = 15) three times. Sonographers collected three audio recordings of scans involving unexpected news communication at baseline(R1), post-Session 1(R2) and post-Session 2(R3), which were rated for communication skills. Participants self-reported communication confidence and burnout before(T1) and after(T2) the intervention. Feedback was collected at T2. Data were analysed using paired-samples t-tests with bootstrapped significance estimates. Results N = 10 sonographers completed the intervention. There were significant increases in communication skills(R1 m = 4.85, SD = 1.07; R3 m = 6.73, SD = 1.80, p = 0.003) and communication confidence(T1 m = 28.00, SD = 6.27; T2 m = 32.80, SD = 6.05, p = 0.005). There were no significant changes in burnout(p > 0.05). All respondents said they would recommend the intervention and most strongly agreed it was engaging(n = 8; 89%) and imparted useful skills(n = 8; 89%). Conclusion Communication coaching is an acceptable, potentially effective tool for improving communication of unexpected news by sonographers in ultrasound. Innovation This is the first evaluation of an intervention to support obstetric sonographers with news delivery

A nonparametric approach to QT interval correction for heart rate.

We propose to use generalized additive models to fit the relationship between QT interval and RR (RR = 60/heart rate), and develop two new methods for correcting the QT for heart rate: the linear additive model and log-transformed linear additive model. The proposed methods are compared with six commonly used parametric models that were used in four clinical trial data sets and a simulated data set. The results show that the linear additive models provide the best fit for the vast majority of individual QT-RR profiles. Moreover, the QT correction formula derived from the linear additive model outperforms other correction methods