Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women’s distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women’s experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.
AdolfssonA.LarssonP. G.WijmaB.BerteroC. (2004). Guilt and emptiness: Women’s experiences of miscarriage. Health Care for Women International, 25, 543–560. doi:10.1080/07399330490444821
BellhouseC.Temple-SmithM.WatsonS.BilardiJ. (2019). “The loss was traumatic . . . some healthcare providers added to that”: Women’s experiences of miscarriage. Women and Birth, 32, 137–146. doi:10.1016/j.wombi.2018.06.006
4.
BrannM. (2015). Nine years later and still waiting: When health care providers’ social support never arrives. In SilvermanR.BagliaJ. (Eds.), Pregnancy loss: A narrative collection (pp. 19–31). New York: Peter Lang.
5.
BrannM.ButeJ. J. (2017). Communicating to promote informed decisions in the context of early pregnancy loss. Patient Education and Counseling, 100, 2269–2274. doi:10.1016/j.pec.2017.06.016
6.
BrierN. (2008). Grief following miscarriage: A comprehensive review of the literature. Journal of Women’s Health, 17, 451–464. doi:10.1089/jwh.2007.0505
7.
ButeJ. J.BrannM. (2015). Co-ownership of private information in the miscarriage context. Journal of Applied Communication Research, 43, 23–43. doi:10.1080/00909882.2014.982686
8.
DaviesB.SteeleR.KruegerG.AlbersheimS.BairdJ.BifirieM.. . . ZhaoY. (2017). Best practice in provider/parent interaction. Qualitative Health Research, 27, 406–420. doi:10.1177/1049732316664712
9.
ErvitiJ.CastroR.ColladoA. (2004). Strategies used by low-income Mexican women to deal with miscarriage and “spontaneous” abortion. Qualitative Health Research, 14, 1058–1076. doi:10.1177/1049732304267693
10.
FallowfieldL.JenkinsV. (2004). Communicating sad, bad, and difficult news in medicine. The Lancet, 363, 312–319. doi:10.1016/S0140-6736(03)15392-5
11.
FordH. B.SchustD. J. (2009). Recurrent pregnancy loss: Etiology, diagnosis, and therapy. Reviews in Obstetrics & Gynecology, 2, 76–83.
12.
FrostJ.BradleyH.LevitasR.SmithL.GarciaJ. (2007). The loss of possibility: Scientisation of death and the special case of early miscarriage. Sociology of Health and Illness, 29, 1003–1022. doi:10.1111/j.1467-9566.2007.01019.x
13.
GairS. (2012). Feeling their stories: Contemplating empathy, insider/outsider positionings, and enriching qualitative research. Qualitative Health Research, 22, 134–143. doi:10.1177/1049732311420580
14.
Hamama-RazY.HemmendingerS.BuchbinderE. (2010). The unifying difference: Dyadic coping with spontaneous abortion among religious Jewish couples. Qualitative Health Research, 20, 251–261. doi:10.1177/1049732309357054
15.
KarkowskyC. E.LandsbergerE. J.BernsteinP. S.DayalA.GoffmanD.MaddenR.ChazotteC. (2016). Breaking bad news in obstetrics: A randomized trial of simulation followed by debriefing or lecture. The Journal of Maternal-Fetal & Neonatal Medicine, 29, 3717–3723. doi:10.3109/14767058.2016.1141888
16.
KempE. C.FloydM. R.McCord-DuncanE.LangF. (2008). Patients prefer the method of “tell back-collaborative inquiry” to assess understanding of medical information. The Journal of the American Board of Family Medicine, 21, 24–30. doi:10.3122/jabfm.2008.01.070093
17.
KingA.HoppeR. B. (2013). “Best practice” for patient-centered communication: A narrative review. Journal of Graduate Medical Education, 5, 385–393. doi:10.4300/JDME-D-13-00072.1
18.
KlitzmanR. (2006). Improving education on doctor-patient relationships and communication: Lessons from doctors who become patients. Academic Medicine, 81, 447–453. doi:10.1097/01.ACM.0000222271.52588.01
19.
KushnerR. F.ZeissD. M.FeinglassJ. M.YelenM. (2014). An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Medical Education, 14, Article 53. doi:10.1186/1472-6920-14-53
20.
MalacridaC. (1999). Complicating mourning: The social economy of perinatal death. Qualitative Health Research, 9, 504–519. doi:10.1177/104973299129122036
21.
MarkoE. K.Buery-JoynerS. D.SheridanM. J.NievesK.KhouryA. N.DalrympleJ. L. (2015). Structured teaching of early pregnancy loss counseling. Obstetrics & Gynecology, 126, 1S–6S. doi:10.1097/AOG.0000000000001015
22.
MastM. S.KindlimannA.LangewitzW. (2005). Recipients’ perspective on breaking bad news: How you put it really makes a difference. Patient Education and Counseling, 58, 244–251. doi:10.1016/j.pec.2005.05.005
23.
MorseJ. (2011). Hearing bad news. Journal of Medical Humanities, 32, 187–211. doi:10.1007/s10912-011-9138-4
24.
Munoz SastreM. T.SorumP. C.MulletE. (2011). Breaking bad news: The patient’s viewpoint. Health Communication, 26, 649–655. doi:10.1080/10410236.2011.561919
25.
NewbleD. (2004). Techniques for measuring clinical competence: Objective structured clinical examinations. Medical Education, 38, 199–203. doi:10.1111/j.1365-2923.2004.01755.x
26.
OlesenM. L.GraungaardA. H.HustedG. R. (2014). Deciding treatment for miscarriage—Experiences of women and health care professionals. Scandinavian Journal of Caring Sciences, 29, 386–394. doi:10.1111/scs.12175
27.
RosenbaumM. E.FergusonK. J.LobasJ. G. (2004). Teaching medical students and residents skills for delivering bad news: a review of strategies. Academic Medicine, 79, 107-117. doi:10.1097/00001888-200402000-00002
28.
SilvermanR. E.BagliaJ. (2015). Introduction: The politics of pregnancy loss. In SilvermanR. E.BagliaJ. (Eds.), Communicating pregnancy loss: Narrative as a method for change (pp. 1–16). New York: Peter Lang. doi:10.3726/978-1-4539-1384-0
29.
SparksL.VillagranM. M.Parker-RaleyJ.CunninghamC. B. (2007). A patient-centered approach to breaking bad news: Communication guidelines for health care providers. Health Communication, 35, 177–196. doi:10.1080/00909880701262997
30.
StreetR. L.Jr.De HaesH. C. J. M. (2013). Designing a curriculum for communication skills training from a theory and evidence-based perspective. Patient Education and Counseling, 93, 27–33. doi:10.1016/j.pec.2013.06.012
31.
SwansonK. M. (2000). Predicting depressive symptoms after miscarriage: A path analysis based on the Lazarus paradigm. Journal of Women’s Health & Gender-Based Medicine, 9, 191–206. doi:10.1089/152460900318696
32.
TracyS. J. (2013). Qualitative research methods: Collecting evidence, crafting analysis, communicating impact. Hoboken, NJ: Wiley-Blackwell.
33.
WalkerJ. L. G.WalkerB. M. (2015). Unscripted loss: A hesitant narrative of a reconstructed family. In SilvermanR. E.BagliaJ. (Eds.), Communicating pregnancy loss: Narrative as a method for change (pp. 59–70). New York: Peter Lang. doi:10.3726/978-1-4539-1384-0
34.
WallaceR. R.GoodmanS.FreedmanL. R.DaltonV. K.HarrisL. H. (2010). Counseling women with early pregnancy failure: Utilizing evidence, preserving preference. Patient Education and Counseling, 81, 454–461. doi:10.1016/j.pec.2010.10.031
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
