Frequency of high-quality communication behaviors used by primary care providers of heterozygous infants after newborn screening

Abstract

Objective To examine the quality of communication likely to be experienced by parents when being first informed about how newborn screening identified heterozygous “carrier” status for cystic fibrosis or sickle cell disease. Methods Primary care providers (PCPs) of infants found to have carrier status were telephoned over a 48-month period, and asked to rehearse with a standardized patient how they would inform the infants’ parent(s). 214 rehearsal transcripts were abstracted using explicit criteria methods to measure the frequency of five categories of high-quality communication behaviors. Results Overall, PCPs used large amounts of jargon and failed to use high quality communication behaviors. On average, PCPs used 18.6 total jargon words (8.7 unique words), but explained 2.4 jargon words. The most frequent assessment of understanding was the close-ended version, although it was only seen in 129 of 214 transcripts. The most common organizing behavior was importance emphasis (121/214). Precautionary empathy was rare; the most frequent behavior was “instruction about emotion” (33/214). Conclusions The limited use of high-quality communication behaviors in rehearsals raises concern about parental understanding, decision-making, and psychosocial outcomes after newborn screening. Practice Implications Measurement of specific behaviors may help PCPs to improve communication, and thereby improve the patient experience.

Benefit of Report Card Feedback After Point-of-Care Assessment of Communication Quality Indicators

“…To fill the gap between initial training and long-term practice, we explored the applicability of the Comm QA approach, which uses methods that are straightforward enough to be implemented by existing personnel on a lean budget so that health care organizations can afford to continue them as part of ongoing QI efforts. [16][17][18][19][20][21][22][23][24][25][26][27][28] The results of this pilot project confirmed our earlier findings 27 that a modest Comm QA intervention can produce quantifiable improvements in specific communication behaviors. We observed nearly a doubling of jargon explanations and a 38% relative improvement in the timing of explanations.…”

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] For example, it is feasible to use communication quality indicators with a heterogeneous set of conversational topics. Feedback was limited to only two groups of quality indicators, reducing the chance that participants would be overwhelmed by a large number of details.…”

“…Abstraction process used previously demonstrated explicit-criteria procedures. [16][17][18][19][20][21][22][23][24] Abstractors were blind to whether transcripts were from baseline or follow-up encounters.…”

“…For regulatory reasons the project was considered to have two components: a QI component based on earlier research, [16][17][18][19][20][21][22][23][24][25][26][27][28] and a secondary research analysis that would use the data from the QI effort to develop new measures. The QI component did not require informed consent from physicians, but the secondary research analysis required informed consent from both physicians and patients.…”

“…The result is an approach that the first author has coined "Communication Quality Assurance" (Comm QA). [16][17][18][19][20][21][22][23][24][25][26][27][28] Comm QA methods are designed to be objective, quantitatively reliable, transparent and unobtrusive enough to be acceptable to busy clinicians as well as straightforward enough to be implemented by existing personnel on a lean budget. Communication behaviors are operationalized using an objective "quality indicator" approach instead of subjective rating scales.…”