Sonographer and patient communication in obstetric settings with adverse findings:Expectations, Challenges and Impacts

Abstract

The aim of the work presented in this thesis was to improve the current communication practices within obstetric ultrasound settings between sonographers and pregnant patients. As frontline practitioners in obstetric ultrasound sonographers face delivering an adverse finding to pregnant patients even though they have little or no autonomy to do so. Evidence indicates such stressful situations have potentially far-reaching emotional consequences with several studies identifying practitioner burnout from the emotional labour associated with delivering patient-centred care. Further, the medically dominant structure of Australia’s healthcare system is a contributing factor in limiting practice autonomy for allied healthcare professionals including sonographers. With limited Australian research on practice challenges for sonographers generally, and specifically obstetrics, this study sought to understand the organisational framework shaping obstetric ultrasound delivery and, specifically, the views and experiences of sonographers on their professional role and autonomy in communicating adverse findings. A mixed methods approach was applied to gain a deeper understanding of sonographers’ experiences in obstetrics, including barriers and challenges to their sense of professional identity and communication role. Findings from the national survey and individual interviews revealed the majority of sonographers felt an ethical responsibility to communicate an adverse outcome, whether or not a sonologist was present at the time. Central to their practice is maintaining a patient’s trust, however this is challenged when one is limited in discussing findings such as an abnormality. Many felt professionally vulnerable with little or no formalised policies, training or support from sonologists. There were some practice site differences: sonographers working directly with obstetricians felt supported in their role, particularly with communicating adverse findings. A majority believed national policies are needed to formalise communication strategies for sonologists and sonographers, particularly for those working in radiology-reporting practices. This research reinforces the complexity of sonographers’ interaction in obstetrics and provides compelling evidence of the limitations placed on their autonomy in communication and how their sense of professional identity can be shaped and reshaped depending on the workplace setting.