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

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.