What type of study is this?

This is a Pre-Registered Trial study.

What question did this study set out to answer?

To examine neonatal physicians’ perceptions of different prognostic framing when delivering serious news.

February 26, 2026Archives of Disease in Childhood Fetal & Neonatal1 citations

Neonatal physicians’ perceptions of message framing when delivering serious news to parents: a randomised crossover study

HSHannah StümerJohannes Gutenberg University Mainz FWFiona A WocheslanderJohannes Gutenberg University Mainz FHFlorian HammerleJohannes Gutenberg University Mainz

Key Points

To examine neonatal physicians’ perceptions of different prognostic framing when delivering serious news.
Conducted as a multicentre, double-blind, randomised crossover study.
Participants were neonatal physicians from tertiary perinatal centres in Germany, Austria, Switzerland, and Italy.
Physicians viewed two videos of conversations varying in message framing about a very preterm infant.
99 out of 115 participants preferred optimistic framing, indicating a strong preference for positive communication.
Optimistic framing led to higher ratings of trust, empathy, and professionalism in physicians.
Framing effects were primarily emotional rather than cognitive, highlighting communication complexities.

Abstract

Objective To examine neonatal physicians’ perceptions of optimistic versus pessimistic prognostic framing when delivering serious news to parents. Design Multicentre, double-blind, randomised crossover study. Setting Conducted online between February and April 2022 at the University Medical Centre Mainz, Germany. Participants Neonatal physicians from tertiary perinatal centres in Germany, Austria, Switzerland and Italy. Intervention Participants viewed two scripted videos of a physician–parent conversation about a very preterm infant with severe intraventricular haemorrhage. Both conveyed identical numerical prognostic estimates but differed in framing: emphasising survival without disability (optimistic) or risk of death and impairment (pessimistic). Main outcome measures Primary outcome was framing preference. Secondary outcomes included Likert scale ratings of parental preparedness, physician professionalism and compassion, prognostic severity and optimism regarding survival and non-impairment, as well as free-text comments on challenges in prognostic communication. Results Of 115 participants, 99 (86%) preferred the optimistic video (period-corrected preference odds (95% CI): 8.6 (7.4 to 9.7)). Optimistic framing was associated with higher ratings of parental preparedness and more favourable evaluations of the consulting physician, including professionalism and compassion, but had no effect on perceived prognostic severity, or optimism about survival or non-impairment. Communication was frequently described as an interpersonal challenge, involving the difficulty of maintaining trust, empathy and hope while communicating under prognostic uncertainty. Conclusions Neonatal physicians strongly preferred optimistic framing. Framing effects were primarily affective rather than cognitive and highlight implicit and complex framing biases in neonatal communication. Trial registration number German Clinical Trials Register (DRKS), www.drks.de/DRKS00024466 .

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