Women's experiences of receiving unexpected findings during obstetric ultrasound in Australia: A mixed-methods survey study.

Abstract

Much research on women's experiences of receiving unexpected findings from obstetric ultrasound has focused on fetal anomalies, limiting understanding of experiences of receiving other findings. New guidelines for parent-centred communication in obstetric ultrasound by the Australasian Society for Ultrasound in Medicine (ASUM) provide a framework within which to begin to address this gap. Our research questions were: (a) what are women's experiences of care and communication when a small- or large-for-gestational age fetus, amniotic fluid or placental complication, or multiple pregnancy is detected during obstetric ultrasound, and (b) are these consistent with ASUM guidelines? Using a cross-sectional mixed-methods online survey, we examined the experiences of 26 women who were informed of at least one of the five candidate findings during or after an ultrasound scan in their most recent pregnancy and who met further criteria. The survey contained multiple choice and open-ended questions, including the Assessment of Communication in Obstetric Ultrasound (ACORN) instrument and the CollaboRATE measure of shared decision-making. In most domains assessed by the ACORN instrument, fewer than a quarter of participants reported optimal quality communication. Domains with the greatest scope for improvement included allowing sufficient time to take in the news (53.8 % said this was done 'a little' or 'not at all') and checking understanding (50 % said this was done 'a little' or 'not at all'). Three participants (11.5 %) experienced shared decision-making once informed of the finding. We identified five themes in participants' open-ended responses: vulnerability and resilience; navigating uncertainty; meaning and understanding; choice, compliance, and consequences; and fragmentation of care. Improvements in ultrasound care delivery are needed, including use of parent-centred communication practices, adoption of shared decision-making, and provision of supporting written resources. These improvements may be facilitated by widespread dissemination of ASUM guidelines.