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Vulnerabilities in clinician–parent exchanges and the cascade of communication traps: a review
  1. Emanuela Ferretti1,
  2. Jordan Richard Schoenherr2,3,
  3. Alessandra Mattiola4,
  4. Thierry Daboval1
  1. 1 Department of Pediatrics, Division of Neonatology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
  2. 2 Department of Psychology, Carleton University, Ottawa, Ontario, Canada
  3. 3 Department of Psychology, Concordia University, Montreal, Quebec, Canada
  4. 4 Centro di Formazione e Simulazione Neonatale NINA, U.O. Neonatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
  1. Correspondence to Dr Emanuela Ferretti, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa K1H 8L1, Canada; eferretti{at}


This review considers parent–clinician interactions that are associated with vulnerabilities in communication and what we refer to as ‘communication traps’. Communication traps are defined by high-stress situations with affect-laden subject matter that can lead to progressively dysfunctional communications/exchanges that are avoidable. While this framework was developed in neonatology, it can be applied to other clinical practices.

Communication competencies in paediatrics require the rapid development of a therapeutic alliance between parents and clinicians to ensure the provision of best care to their infants. In order to facilitate parent–clinician communication, our framework focuses clinicians’ attention on the affective, behavioural and cognitive (ABC) cues that are indicative of real, apparent or potential communication traps. Strategies are provided to slow down clinicians’ responses to more effectively consider ABC cues that suggest if patients/parents have failed to engage or disengage from a situation. This framework is illustrated by presenting a narrative synthesised from a number of experiences that clinicians have encountered. This review identifies key decision points in the communication process that, if left unaddressed, can cascade into communication traps which may be difficult to escape.

Using results from communication studies and psychological research, our framework was developed to identify key decision points for ABC cues that can be used to prevent falling into communication traps.

  • Neonatology
  • Paediatrics
  • Ethics
  • Psychology
  • Primary Health Care

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  • Contributors EF drafted the manuscript; created figures 1, 3 and descriptions; and coordinated, reviewed and revised the manuscript. JRS created figure 2 and table 1, reviewed and revised the overall content related to psychology research of the manuscript. AM revised the content related to psychology research of the manuscript. TD reviewed and revised the manuscript, figures and descriptions. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.