Accordance with the characteristics of a communication quality, professional ethical approaches described and the description of informed consent, ten steps can be suggested to promote a constructive debate. These steps describe the process followed to arrive at a consensus decision.
Characteristics of a decision
Building a trusting relationship
It is important that parents feel supported by the medical team in what they live, they do not feel judged and that their fears and suffering be accepted. Tools can help physicians develop a trusting relationship. Training in this sense can sometimes be very useful. If the doctor fails to establish and maintain a trusting relationship with the family, it will be harder to continue the process and reach consensus.
Obtain relevant information
In addition to obtaining medical information obstetric data regarding fetal well-being and psychosocial circumstances of the family, the physician should validate emotions, beliefs, values and wishes of the family. These data will influence the options that the doctor can give parents. By focusing on this information, the physician demonstrates an understanding of the general situation of parents, which helps to establish and maintain a trusting relationship. It must also review the individual wishes of the father and mother, who may sometimes differ, and allow everyone to express them. The extended family can participate, which can sometimes facilitate communication.
In addition, physicians should learn about the systems of values and emotions that influence its decisions. It may well identify values inconsistent with those of parents to effectively communicate the information necessary to make a choice.
Provide the information necessary to make a choice
It is essential to summarize the information gathered and discuss the prognosis. It is not essential to give exact figures on the possible complications of prematurity. An overview of the opportunities that may present only in premature babies. Uncertainties should be disclosed.
The doctor should explain tactfully factors (beliefs, values, emotions) that may influence the decision and potentially create a conflict. However, conflict can be resolved by establishing the most important values with parents.
Finally, the doctor can offer treatment options tailored to the situation. It is not always useful to present that goes against the interests of the child and what is considered futile. The physician should provide a range of treatment options. Parents can choose, or at least give a general idea of their wishes in light of the discussions, which will help guide interventions. In most cases, a full response or a non-intervention is preferred. It is possible to treat the child according to predetermined therapeutic levels (oxygen therapy, manual ventilation, mechanical ventilation, chest compressions, resuscitative drugs, etc..) And for stopping treatment at different stages of the intervention process.
Ensure understanding of parents
We should check if parents understand by asking them to explain their understanding in their own words. The doctor can then correct or qualify as required. It is not yet time to obtain consent.
Allow time for reflection and dialogue for parents and doctors
It is important to allow parents or family only a few minutes or days, depending on the urgency of the situation. This important step allows parents to integrate information received and make a treatment decision for their child.
While parents discuss, the physician should confirm with his colleagues, medical staff and other sources, if necessary, the orientation of the therapeutic choices available. It will avoid possible errors in judgment.
Make a joint decision
It was then that occurs the joint decision making with parents. Most parents can make a decision while the doctor retains a degree of neutrality, but it happens that some parents ask the doctor to help them in their decision, they seek approval or opinion. The physician should then compromise and provide advice regarding the situation, given the state of the child, parents' wishes and what he considers suitable. It is not to entrust what he would do as an individual or parent in this situation, but to help parents make a decision that suits them and which protects the interests of the child.
If a conflict emerges, the doctor should try to avoid discussing again with colleagues to assess whether the parents' decision is valid or not. It should review the possible communication errors during the previous steps, reassess the missing data, and transmit relevant information to ensure understanding of parents.