Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

Abstract

Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care. INTRODUCTION/OVERVIEWHealth care communication is a critical, but generally neglected, component of pediatric and pediatric subspecialty practice and training and is a skill that can and must be taught. [1][2][3][4][5][6][7][8][9][10][11][12][13] The practicing clinician's ability to communicate openly and with compassion is essential for effective and efficient routine health care; this ability becomes a vital lifeline for parents and children confronted with lifealtering and sometimes life-ending conditions. [13][14][15][16] The purpose of this report is to provide research-based and practical guidance to enable effective communication with pediatric patients and their families in a number of common settings and situations. Although child abuse, sexuality, divorce, and many other situations are not individually addressed, the principles and approaches discussed apply equally to these situations.Communication is the most common "procedure" in medicine. Health care communication is different from normal social discourse, because intimate and very private issues are often discussed. These include hopes and fears, developmental concerns, sexuality, and mental health disorders. Painful issues, such as abuse, school failure, drug use, and terminal illness, are also discussed. Communication is the foundation of the therapeutic relationship; it is the basis of fiduciary and ethical obligations of physicians to patients and their families. Effective health care communication is an essential tool for accurate diagnosis [17][18][19] and for the development of a successful treatment plan, 20-23 correlating with improved patient knowledge, 15,24 functional status, 25,26 adherence to the agreed-on treatment regimen, 20,21,27-32 improved psychological and behavioral outcomes, 15,33-36 and even reduced surgical morbidity. 3,4,37 In the case of distressing news, skillful communication can enable a family to adapt better to a challenging situation, 12,38,39 including a child's unanticipated impairments. [40][41][42][43] Poor communication, on the other hand, can prompt lifelong anger 31,42,44-48 and regret, 14,40 can result in compromised outcomes for the patient and family, and can have medicolegal consequences for the practitioner. 49

Experience of Primary Care Services Among Early Adolescents in England and Association With Health Outcomes

“…(9,10,25) Conversely, being able to talk to a trusted doctor may be particularly important for many of the most vulnerable young people, and may be have an important protective effect on future health outcomes. (26) Constructive and supportive relationships with adults -both teachers and parents -have been strongly and independently associated with contributing a protective health effect for young people. (27)(28)(29) The findings presented here suggest that GPs could also constitute an important additional element in the set of constructive adult relationships around the adolescent.…”

Death of a Child in the Emergency Department

“…10 Nurses may also be ineffective in communication. 11 In a 2008 AAP statement reviewing communication skills, 12 it was noted that "health care communication is currently learned primarily through trial and error." There is increasing evidence that communication skills can and should be taught and learned, 13 and there are a number of strategies specific to the practice of emergency care.…”

Caring for Pediatric Patients’ Families at the Child’s End of Life

“…When other family members are present, arrangements for additional seating, including a rocking chair for parents, may make the room more comfortable. 9,11,35 Nurses can offer the family space to pray, sing, and talk to their child. Nurses can also propose opportunities for parents to hold or lie in bed with their child and to help with bathing and dressing, if the parents wish to do so.…”