CPD Short: Sonographer-patient communication

By Holly Spencer, PhD student at Sheffield Hallam University and sonographer (Diagnostic Radiographer)

Effective communication is the cornerstone of person-centred care; it reduces anxiety, fosters trust, improves cooperation, and enhances the overall quality of patient care (1–3).

In obstetric ultrasound, where sonographers may need to communicate unexpected news to expectant parents, there has been a growing awareness of the need for improved news delivery. 

Studies suggest that a significant proportion of both expectant parents and sonographers prefer unexpected news to be delivered immediately by sonographers (4–8).

However, this practice has been cited as a significant stressor and contributor to sonographer burnout (4,9,10). 

For expectant parents, the manner in which complications are initially communicated has a significant emotional impact, with better experiences enabling a more supported pathway of decision-making and wellbeing (11).

Principles of news delivery

Evidently, sonographer-patient communication has significant implications for both parties. 

This realisation has prompted the development of evidence-based interventions for the benefit of expectant parents and sonographers alike. Such interventions include the ‘UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS (Avoid assumptions; Set up the scan; Clear, honest information; Kindness; Self-care) framework’ (12,13). 

This CPD Short outlines the key principles of news delivery, as described by the framework. It is worth noting that, while these principles are aimed at the obstetric ultrasound setting, some can be applied to any area of ultrasound practice. 

Five key principles, as outlined in the ASCKS framework (12) 

• Avoid assumptions: Remain aware that people may not react in the way you might expect them to. Use neutral terms (e.g. ‘unexpected’ rather than ‘abnormal’) and make no assumptions.
• Set up the scan: Gathering information and setting expectations prior to all scans can facilitate better communication in those where unexpected findings are identified. Use the preamble prior to undertaking the scan to:
  • Introduce yourself and your role.
  • Check understanding about the purpose of the scan.
  • Assess feelings about the pregnancy.
  • Explain that you will be silent at times during the scan. 
  • Check consent for the scan and any screening.
  • Explain when and how you will show them the monitor.
  • In the first trimester, also check their pregnancy dates and explain if you think an internal scan might be needed.
• Clear, honest information: Providing expectant parents with clear, honest information can help them to understand and process the news. The following suggestions can support clear communication:
  • Put down the probe, turn, and make eye contact before verbally communicating the news.
  • Use technical terms, but also provide the ‘lay translation’ of what these mean.
  • Communicate exactly what will happen next and why – whether this is an internal scan or leaving the room to seek a second opinion.
  • Wherever possible, offer written information and signpost to relevant organisations which can offer further information and/or support.
• Kindness: Kindness and compassion are key to better news delivery. The following suggestions can support kindness in news delivery situations:
  • Unless you hear expectant parents using other terminology (e.g. ‘foetus’), use the term ‘baby’ as a default, even in very early pregnancy.
  • Understand the nature of shock: it is a common phase where parents ‘make sense’ of the news they have been told. People struggle to assimilate new information during this time; avoid asking them to immediately make decisions around pregnancy management.
  • Express regret: Where a condition has been found, hold the ‘I’m sorry’ until after you have delivered the initial news and only if this feels appropriate. In doing this, you are expressing regret about their distress, not the finding itself.
• Self-care: Remember that delivering unexpected news via ultrasound is uniquely demanding. Have compassion for yourself, as well as those you are scanning. Explore coping strategies which are useful to you and make time to care for yourself.

Reflection prompts

• Can you recall a time, when delivering unexpected news, that your communication style either positively or negatively influenced the interaction?
• Which of the five principles (Avoid assumptions; Set up the scan; Clear, honest information; Kindness; Self-care) do you find the easiest to implement and why?
• Which of the five principles (Avoid assumptions; Set up the scan; Clear, honest information; Kindness; Self-care) do you find the most challenging to implement and why?
• What support or training might help you to better integrate these principles into your routine practice?
• Can you adapt these principles to other ultrasound settings beyond obstetrics?

Further reading/ references

1. Beardmore C, England A, Cruwys C, Carrié D, on behalf of the European Federation of Radiographer Societies, and the European Society of Radiology. How can effective communication help radiographers meet the expectations of patients — COMMUNICATION — a joint statement by the ESR and EFRS. Insights into Imaging. 2024 Dec 19;15(1):300.

2. Pollard N, Lincoln M, Nisbet G, Penman M. Patient perceptions of communication with diagnostic radiographers. Radiography. 2019 Nov 1;25(4):333–8.

3. Hyde E, Hardy M. Patient centred care in diagnostic radiography (Part 2): A qualitative study of the perceptions of service users and service deliverers. Radiography. 2021 May 1;27(2):322–31.

4. Simpson R, Bor R. ‘I’m not picking up a heart-beat’: Experiences of sonographers giving bad news to women during ultrasound scans. British Journal of Medical Psychology. 2001;74(2):255–72.

5. Johnson J, Johnson O, Heyhoe J, Fielder C, Dunning A. Parent Experiences and Preferences When Dysmelia Is Identified During the Prenatal and Perinatal Periods: A Qualitative Study Into Family Nursing Care for Rare Diseases. J Fam Nurs. 2018 May 1;24(2):271–93.

6. Thomas S, O’Loughlin K, Clarke J. The 21st century sonographer: Role ambiguity in communicating an adverse outcome in obstetric ultrasound. Schumacher U, editor. Cogent Medicine. 2017 Jan 1;4(1):1373903.

7. Mitchell LM. Women’s experiences of unexpected ultrasound findings. Journal of Midwifery & Women’s Health. 2004 May 1;49(3):228–34.

8. Johnson J, Dunning A, Sattar R, Arezina J, Karkowsky EC, Thomas S, et al. Delivering unexpected news via obstetric ultrasound: A systematic review and meta-ethnographic synthesis of expectant parent and staff experiences. Sonography. 2020;7(2):61–77.

9. Johnson J, Arezina J, McGuinness A, Culpan AM, Hall L. Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful? Ultrasound. 2019 Feb;27(1):55–63.

10. Hardicre NK, Arezina J, McGuinness A, Johnson J. Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery. Radiography. 2021 May 1;27(2):369–76.

11. Bijma HH, van der Heide A, Wildschut HIJ. Decision-Making after Ultrasound Diagnosis of Fetal Abnormality. Reproductive Health Matters. 2008 Jan 1;16(sup31):82–9.

12. Johnson J, Arezina J, Tomlin L, Alt S, Arnold J, Bailey S, et al. UK consensus guidelines for the delivery of unexpected news in obstetric ultrasound: The ASCKS framework. Ultrasound. 2020 Nov 1;28(4):235–45.

13. Alt S, Arezina J, Arnold J, Bailey S, Beety H, Bender-Atik R, et al. Consensus guidelines on the communication of unexpected news via ultrasound [Internet]. University of Leeds; 2020 [cited 2025 Mar 1]. Available from: https://sands.org.uk/professionalsprofessional-resources/communicating-unexpected-news-
during-pregnancy