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This is a tool for use in neonatal practice to enhance communication and shared decision making in the context of neonatal brain injury. The aim is to do this through supporting the reflection of individuals and team members involved in the challenging task of predicting outcomes for neonates with acute brain injury and to support discussing likely outcomes and their impact with parents.

The ‘ouR‐HOPE’ approach for ethics and communication about neonatal neurological injury

Knowledge Hub

This is a tool for use in neonatal practice to enhance communication and shared decision making in the context of neonatal brain injury. The aim is to do this through supporting the reflection of individuals and team members involved in the challenging task of predicting outcomes for neonates with acute brain injury and to support discussing likely outcomes and their impact with parents.

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Synopsis of resource:

Communication of short and long term outcomes including comfort care in neurologically compromised infants in a neonatal setting is a challenging shared decision making & delivering process which needs consensus as well as competence. This has a long term implications for parental coping & planning future actions    

 The uncertainty in this exercise is due to intrinsic factors like neuroplasticity and extrinsic factors like SES of parents, Parental involvement, accessibility to appropriate & timely services and psychological state of the family groping with the difficult situation. 

Communication under these circumstances has innate challenges to many of the personal bias & individual perspectives of professionals. 

 There is a need for having an ethically, scientifically & culturally sound approach for this and this excellent article offers one such module called ouR-HOPE– Reflection, Humility, Open mindedness, Partnership & Engagement. Stand out part of  this article is the set of questions for self -examination on these concepts for practitioners all of which are aptly defined & relevance explained.

Key learning outcomes

  • Importance as well as challenges of prognosticating neurological injury in neonatal setting 
  • Uncertainty in neurological  injury short & long term outcomes 
  • Different perspectives of professionals& parents involved 
  • Ethical  aspects 
  • a proposed self reflection questionnaire for the approach.

Authors

Eric Racine, Ph.D., is Research Professor and Director of the Pragmatic Health Ethics Research Unit at the Montreal Clinical Research Institute (IRCM) with additional appointments at University of Montreal and McGill University. A leading international researcher in bioethics with recognized contributions to the development of neuroethics and pragmatic ethics,  he has published 170+ peer reviewed papers and presented 150+ lectures in more than 20 countries.  Inspired by philosophical pragmatism, his research aims to bring to the forefront the lived experience of ethically problematic situations by patients and stakeholders and then to resolve them collaboratively through deliberative and evidence-informed processes. 

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