Article

Predicting neurological outcomes of neonates with acute brain injury is an
essential component of shared decision-making, in order to guide the development
of treatment goals and appropriate care plans. It can aid parents in imagining
the child's future, and guide timely and ongoing treatment decisions, including
shifting treatment goals and focusing on comfort care. However, numerous
challenges have been reported with respect to evidence-based practices for
prognostication such as biases about prognosis among clinicians. Additionally,
the evaluation or appreciation of living with disability can differ, including
the well-known disability paradox where patients self-report a good quality of
life in spite of severe disability. Herein, we put forward a set of five practice
principles captured in the "ouR-HOPE" approach (Reflection, Humility,
Open-mindedness, Partnership, and Engagement) and related questions to encourage
clinicians to self-assess their practice and engage with others in responding to
these challenges. We hope that this proposal paves the way to greater discussion
and attention to ethical aspects of communicating prognosis in the context of
neonatal brain injury.
CI - (c) 2016 The Authors. Developmental Medicine & Child Neurology published by John
Wiley & Sons Ltd on behalf of Mac Keith Press.

Langue : ANGLAIS