Advice for radiologists when counseling about prenatal abnormalities
One of the more unpleasant situations a pediatric radiologist may encounter is when it is necessary to convey the findings of a radiological examination to a parent or expectant parent. An article published in the February 2016 issue of Pediatric Radiology offers practical recommendations for prenatal counseling that are also applicable for use with the parent(s) of pediatric patients as well.
Pediatric radiologists may be asked to join a multidisciplinary team of physicians and genetic counselors when complex abnormalities have been identified in fetal imaging. While most major fetal abnormalities are identified by routine ultrasound in the 18th to 22nd week of gestation, some major malformations may be detected in the first trimester or late in the third trimester. It is in these situations when an obstetrician may invite the radiologist to join a meeting with the prospective parents.
Prior to the meeting, the radiologist should personally review the patient’s medical records, paying close attention to prenatal screening outcomes and diagnostic testing results. Co-author Dorothy I. Bulas, a radiologist at the Fetal Medicine Institute of Children’s National Health System in Washington, D.C., and colleagues, advise that this is important in situations when a pregnant patient who has been told that all of her testing during pregnancy has been normal assumes that all birth defects and genetic syndromes have been ruled out.
The radiologist also should learn the names of the clinical team members who will be meeting the patient. Ideally, the entire team should communicate in advance to discuss the patient’s clinical history, most recent imaging findings, and to plan a clear message to convey to the patient. This also should be done if any of the team members will be meeting the patient separately. A consistent message to the patient is extremely important. The authors recommend that the team should also stay in communication after the meeting has taken place to review the patient’s decisions and to develop a prompt response to any unanswered questions.
In all likelihood, the meeting will be led by the patient’s obstetrician or a genetic counselor. However, a participating radiologist should think about in advance what questions and concerns the family may ask, and prepare answers for these questions as well as the information they are going to provide. The radiologist should also be prepared to explain medical terms that may be used, and be prepared to use drawings and images. If a radiologist is asked a question, and doesn’t know the answer, he/she should say so and offer to get the information.
Additional recommendations include:
- Being alert and visually engaged with the patient and other participants during the entire meeting, and maintaining positive body language (i.e., no crossed arms).
- Avoid looking at a watch or muted cell phone.
- Knowing if the patient/family wants to know the gender of the fetus, and NOT mentioning it if they do not.
- Avoid making any comment that might offend or potential hurt, such as stating that the pregnancy “wasn’t meant to be” or that the patient could “try again”.
- Expressing sincere sympathy and empathy to the patient, and assuring the patient that the fetal abnormality is not her fault.
“A little extra effort can go a long way in these situations. A squeeze of the patient’s hand or a follow-up phone call to check in after the consultation can make all the difference to a family,” the authors write. And while this advice may be especially poignant to an expectant parent needing to make a choice for an unborn infant, it is also true when providing radiological expertise about a difficult situation to the parent of a child.
REFERENCE
- Lawrence AK, Menzel MB, Bulas DI. Prenatal counseling tools for the pediatric radiologist as part of a multidisciplinary team. 2016 Pediatr Radiol. 46;2:172-176.