Missing the heart of the matter: Limitations of parental understanding during prenatal consultations for normal fetal echocardiograms

Abstract Background Congenital heart disease is the most common congenital malformation worldwide. Prenatal diagnosis provides the opportunity to counsel parents and help them prepare for their future with their child. This study aimed to assess parental knowledge following a prenatal consultation with a pediatric cardiologist for a normal fetal echocardiogram. Improved parental communication in prenatal consultations with pediatric cardiologists is critical to improving outcomes for these children and their families. Methods. This prospective questionnaire based descriptive study was conducted at a single regional perinatal center with a level four neonatal intensive care unit and a dedicated infant cardiac intensive care unit. After prenatal consults with a pediatric cardiologist, surveys were administered to consenting parents that received a normal fetal echocardiogram result and their pediatric cardiologists. Results From November 2020 to April 2021, 50 parents completed the survey, 34 of whom reported English as their primary language. Of the 16 parents reporting a different primary language, ten parents preferred the consultation to occur in English, and six preferred the consultation in Spanish. Multivariate regression analysis revealed that the presence of a language barrier was associated with decreased understanding of the limitations of a normal fetal echocardiogram (14% vs 84%, p < 0.001) and follow-up recommendations (29% vs 91%, p < 0.01). There was a trend toward decreased understanding with lower education levels, but this difference was not statistically significant. Despite limitations in comprehension, parents and cardiologists were satisfied with the consults and perceived parental understanding as good or extremely good. Conclusion Limited English proficiency is an important barrier to comprehension during prenatal consultations with pediatric cardiologists even when best practices of in-person medical interpreters are used. Objective evaluation of parental understanding is critical given that parents and cardiologists may not accurately perceive limitations in knowledge.