UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework
Judith Johnson, Jane Arezina, Liz Tomlin, Siobhan Alt, Jon Arnold, Sarah Bailey, Hannah Beety, Ruth Bender-Atik, Louise Bryant, Jen Coates, Sam Collinge, Jo Fishburn, Jane Fisher, J.A. Fowler, Tracey Glanville, Julian Hallett, Ailith Harley-Roberts, Gill Harrison, Karen Horwood, Catriona Hynes, Lindsay Kimm, Alison McGuinness, Lucy Potter, Liane Powell, Janelle Ramsay, Pieta Shakes, Roxanne Sicklen, Alexander J. Sims, Tomasina Stacey, Anushka Sumra, Samantha Thomas, K Shackelford Todd, Jacquie Torrington, Rebecca C. Trueman, Lorraine Walsh, Katherine E. Watkins, Gill Yaz, Natasha Hardicre
Abstract
Background Studies indicate there is a need to improve the delivery of unexpected news via obstetric ultrasound, but there have been few advances in this area. One factor preventing improvement has been a lack of consensus regarding the appropriate phrases and behaviours which sonographers and ultrasound practitioners should use in these situations. Aims To develop consensus guidelines for unexpected news delivery in Early Pregnancy Unit and Fetal Anomaly Screening Programme NHS settings. Methods A workshop was conducted to identify priorities and reach consensus on areas of contention. Contributors included interdisciplinary healthcare professionals, policy experts, representatives from third-sector organisations, lay experts and academic researchers ( n = 28). Written and verbal feedback was used to draft initial guidance which was then circulated amongst the wider writing group ( n = 39). Revisions were undertaken until consensus was reached. Results Consensus guidelines were developed outlining the behaviours and phrases which should be used during scans where unexpected findings are identified. Specific recommendations included that: honest and clear communication should be prioritised, even with uncertain findings; technical terms should be used, but these should be written down together with their lay interpretations; unless expectant parents use other terminology (e.g. ‘foetus’), the term ‘baby’ should be used as a default, even in early pregnancy; at the initial news disclosure, communication should focus on information provision. Expectant parents should not be asked to make decisions during the scan. Conclusions These recommendations can be used to develop and improve news delivery interventions in obstetric ultrasound settings. The full guidelines can be accessed online as supplemental material and at https://doi.org/10.5518/100/24 .