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. 2021 Nov 17;10(22):5347.
doi: 10.3390/jcm10225347.

Facilitators and Strategies for Breaking the News of an Intrauterine Death-A Mixed Methods Study among Obstetricians

Dana Anais Muin  1 , Janina Sophie Erlacher  1 , Stephanie Leutgeb  2 , Anna Felnhofer  3
Affiliations

Facilitators and Strategies for Breaking the News of an Intrauterine Death-A Mixed Methods Study among Obstetricians

Dana Anais Muin et al. J Clin Med. .

Abstract

(1) Background: The death of a baby in utero is a very sad event for both the affected parents and the caring doctors. By this study, we aimed to assess the tools, which may help obstetricians to overcome this challenge in their profession. (2) Methods: We conducted a cross-sectional online survey in 1526 obstetricians registered with the Austrian Society of Obstetrics and Gynecology between September and October 2020. (3) Results: With a response rate of 24.2% (n = 439), our study shows that diagnosing fetal death was associated with a moderate to high degree of stress, regardless of position (p = 0.949), age (p = 0.110), gender (p = 0.155), and experience (p = 0.150) of physicians. Coping strategies for delivering the news of intrauterine death to affected parents were relying on clinical knowledge and high levels of self-confidence (55.0%; 203/369), support from colleagues (53.9%; 199/369), and debriefing (52.8%; 195/369). In general, facilitators for breaking bad news were more commonly cultivated by female obstetricians [OR 1.267 (95% CI 1.149-1.396); p < 0.001], residents [χ2(3;369) = 9.937; p = 0.019], and obstetricians of younger age [41 (34-50) years vs. 45 (36-55) years; p = 0.018]. External facilitators were most frequently mentioned, including professional support, training, professional guidance, time, parents' leaflets, follow-up consultations, a supporting consultation atmosphere, and preparation before delivering the bad news. Internal facilitators included knowledge, empathy, seeking silence, reflection, privacy, and relief of guilt. (4) Conclusions: Communicating the diagnosis of fetal death evokes moderate to high levels of stress among obstetricians. Resources from both the professional and private environment are required to deal with this professional challenge on a personal level.

Keywords: breaking bad news; coping strategies; fetal death; intrauterine death; resilience; stillbirth; stress.

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Conflict of interest statement

The authors declare no conflict of interest. No funding was received for conduction of this study.

Figures

Figure 1
Figure 1
Flowchart illustrating the enrolment of participants (n = 369) to the survey conducted by the Austrian Society of Obstetrics and Gynecology between 21 September 2020 and 31 October 2020.
Figure 2
Figure 2
Clustered bar chart on stress levels (i.e., very high; high; moderate; low; very low) in obstetricians when diagnosing fetal death.
Figure 3
Figure 3
Clustered bar chart on the frequency of coping strategies among obstetricians for breaking news of fetal death.
Figure 4
Figure 4
Clustered bar chart on the frequency of strategies among obstetricians for coping with stressful obstetric events.
Figure 5
Figure 5
Graphical theme cloud illustrating obstetricians’ external and internal facilitators for breaking news of fetal death to affected parents. The size of the circles directly correlates with the number of positive replies by obstetricians. The color of the circles represents the respective professional group, which predominantly quoted this element in the open response (i.e., residents; specialist doctors in hospital and practice, respectively; departmental heads).
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References

    1. Mohangoo A.D., Buitendijk S.E., Szamotulska K., Chalmers J., Irgens L.M., Bolumar F., Nijhuis J.G., Zeitlin J. Gestational age patterns of fetal and neonatal mortality in Europe: Results from the Euro-Peristat project. PLoS ONE. 2011;6:e24727. doi: 10.1371/journal.pone.0024727. - DOI - PMC - PubMed
    1. Nuzum D., Meaney S., O’Donoghue K. The impact of stillbirth on bereaved parents: A qualitative study. PLoS ONE. 2018;13:e0191635. doi: 10.1371/journal.pone.0191635. - DOI - PMC - PubMed
    1. Nuzum D., Meaney S., O’Donoghue K. The impact of stillbirth on consultant obstetrician gynaecologists: A qualitative study. BJOG Int. J. Obstet. Gynaecol. 2014;121:1020–1028. doi: 10.1111/1471-0528.12695. - DOI - PubMed
    1. Nuzum D., Meaney S., O’Donoghue K. The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study. J. Relig. Health. 2016;55:1519–1528. doi: 10.1007/s10943-015-0077-7. - DOI - PubMed
    1. Korteweg F.J., Gordijn S.J., Timmer A., Erwich J.J., Bergman K.A., Bouman K., Ravise J.M., Heringa M.P., Holm J.P. The Tulip classification of perinatal mortality: Introduction and multidisciplinary inter-rater agreement. BJOG Int. J. Obstet. Gynaecol. 2006;113:393–401. doi: 10.1111/j.1471-0528.2006.00881.x. - DOI - PubMed