EBNEO Commentary: Clinician Opinion Disclosure and Parental Decision-Making in the Neonatal Intensive Care Unit

Barah Hassan and Professor Prakash Kannan Loganathan from UK review January 2026 #ebneo Article of the Month "Eychmüller J, Kidszun A, Hediger D, Jaisli S, Schmid SV, Arnold C. Clinician Opinion Disclosure and Parental Decision-Making in the Neonatal Intensive Care Unit: A Randomized Clinical Trial. JAMA Pediatr. 2026; 180(1): 98-99. PMID 41143839"

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ACTA PAEDIATRICA COMMENTARY:

Acta Paediatrica - 2026 - Hassan - EBNEO Commentary Clinician Opinion Disclosure and Parental Decision‐Making in the.pdf

"This randomised trial addresses a common but challenging question in neonatology: “What would you do if this were your child?” Many communication frameworks caution against uninvited disclosure of personal opinions because of the risk of paternalism and undue influence. Instead, contemporary neonatal communication emphasises shared decision-making, where clinicians provide expertise and guidance while supporting parental values and involvement in decisions, particularly when outcomes are uncertain. This study therefore explores whether disclosure of a clinician’s personal opinion affects parental preparation for decision-making in a simulated neonatal tracheostomy consultation.

The study’s strengths include its randomised design, clinically relevant question, standardised video scenarios, and structured statistical analysis. However, the findings require cautious interpretation. Parents with previous NICU experience are an appropriate study population, but their prior conversations and infant outcomes may have shaped their responses. Tracheostomy is also a relatively uncommon outcome of extreme prematurity, and only five infants in this cohort were discharged with a tracheostomy. Therefore, most participants were unlikely to have direct experience of this specific decision, limiting applicability to families facing real tracheostomy counselling. Although 52.8% preferred the disclosure version, nearly half preferred withholding the clinician’s personal opinion, reinforcing that there is unlikely to be a single correct communication style. Further limitations include the hypothetical nature of the intervention, use of animated videos, and testing only one direction of clinician opinion - an opinion against tracheostomy - without evaluating a clinician opinion supporting tracheostomy. Attrition was high, raising selection bias. The cohort was predominantly female and largely consisted of parents of infants born around 30 weeks’ gestation, most of whom had limited respiratory support needs at discharge. This makes them poorly representative of parents facing decisions after prolonged ventilation or severe chronic lung disease. The time elapsed since neonatal admission also introduces recall bias and response shift.

Depressive symptoms were negatively associated with decision-making preparation, highlighting the importance of parental emotional state during complex counselling. Generalisability is further limited by inclusion of only German-speaking parents from three European countries, as cultural beliefs, attitudes to clinician authority, disability, and life-sustaining treatment may influence responses. The simulation also cannot capture the effect of trust, continuity, and the duration of the clinician–family relationship. Clinician opinion disclosure should not be viewed as a binary choice, but as part of a structured, values-sensitive conversation.

Overall, this study suggests that structured clinician opinion disclosure may not undermine parental preparation for decision-making in a simulated setting. However, the findings should not be over-interpreted as evidence that personal opinion disclosure is neutral or universally appropriate. Rather, they support individualised shared decision-making, where clinicians provide guidance within a values-sensitive conversation while preserving parents’ role as equal partners."