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Hard Decisions for the Littlest Lives
Date:10/1/2008

in decisions regarding delivery-room resuscitation, few could recall discussing the full range of options with doctors. And fewer still remembered being offered comfort care for their infant as an option, even when these discussions were written in the hospitals' medical charts.

Doctors and mothers also spoke in -- almost literally -- different languages, with mothers often confused by what the doctors were saying, found the study, published in the September issue of the journal Pediatrics.

While parents often predicated their life-and-death decisions on issues of religion, spirituality and hope, physicians were framing their discussions in terms of death and disability.

Moms were also more likely to regard physicians as providing hope -- not when they predicted the infant would not die, but when they expressed emotion even while reporting that the chances of survival were slim.

Much of the onus for clarifying communication lies with the physician or the system providing care, the study authors and others stated.

"I think doctors do need to be able to have attending skills or "being with" skills where they need to read the cues of the family," said Chaplain Paul Beckman of Cincinnati Children's Hospital Medical Center. "I have seen times when the doctor does not even know the sex of the baby or the name of the baby. It does take time. The doctor may have to sit with the family for half an hour instead of 10 minutes. The doctor may have to get one of his or her residents or a colleague to take his pager."

The doctor should also be in touch with the chaplain or social worker and, if possible, the chaplain or social worker should sit in on any conversations, the experts said.

A doctor may say, "There's nothing we can do for this child," and forget to add that in the short-term, parents can be given an opportunity to connect with the child.

"If it means aggressive treatment or res
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