How do paediatricians communicate with children and parents?

Wassmer, Evangeline; Minnaar, Gregory; Aal, N Abdel; Atkinson, Morgan; Gupta, Ekta; Yuen, Sam Chun Sum; Rylance, G

doi:10.1080/08035250410015079

Cited by 25 publications

(14 citation statements)

References 21 publications

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“…Providers did not often elicit information from parents; nor did many parents volunteer information about their goals and preferences. Consistent with other observations of pediatric clinical encounters,(4, 16, 30, 31) very little effort was made to include patients, of any age, in decision making.…”

Section: Discussionmentioning

confidence: 72%

Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making

Lipstein

Dodds

Britto

2014

The Journal of Pediatrics

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Objective To use observation to understand how decisions about higher-risk treatments, such as biologics, are made in pediatric chronic conditions. Methods Gastroenterology and rheumatology providers who prescribe biologics were recruited. Families were recruited when they had an outpatient appointment in which treatment with biologics was likely to be discussed. Consent/assent was obtained to video the visit. Audio of the visits in which a discussion of biologics took place were transcribed and analyzed. Our coding structure was based on prior research, shared decision-making concepts, and the initial recorded visits. Coded data were analyzed using content analysis and comparison with an existing model of shared decision making. Results We recorded 21 visits that included discussions of biologics. In most visits, providers initiated the decision making discussion. Detailed information was typically given about the provider’s preferred option with less information about other options. There was minimal elicitation of preferences, treatment goals or prior knowledge. Few parents or patients spontaneously stated their preferences or concerns. An implicit or explicit treatment recommendation was given in nearly all visits, although rarely requested. In approximately 1/3 of visits the treatment decision was never made explicit, yet steps were taken to implement the provider’s preferred treatment. Conclusion We observed limited use of shared decision making, despite previous research indicating that parents wish to collaborate in decision making. To better achieve shared decision making in chronic conditions, providers and families need to strive for bidirectional sharing of information and an explicit family role in decision making.

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Section: Discussionmentioning

confidence: 72%

Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making

Lipstein

Dodds

Britto

2014

The Journal of Pediatrics

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“…Overall levels of child and adolescent verbal participation in clinical and research settings are low (Cox, Smith, Brown, & Fitzpatrick, 2009; Miller, Baker, Leek, Drotar, & Kodish, 2014; Sleath et al, 2011; van Staa & On Your Own Feet Research Group, 2011; Wassmer et al, 2004). Youth may not speak up in health care settings for a variety of reasons (Young, Dixon-Woods, Windridge, & Heney, 2003), and other factors, such as how the clinician or researcher speaks to them, may be more important in shaping their perceptions of the decision making process.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, reducing variability in the target protocols may help to isolate the effects of decision making involvement on specific outcomes. Third, prior research in the clinical care context suggests that the dynamics of the child-parent-researcher triad may be important for future efforts to understand and facilitate assent to research participation (Savage & Callery, 2007; Tates, Meeuwesen, Elbers, & Bensing, 2002; van Staa & On Your Own Feet Research Group, 2011; Wassmer et al, 2004). Fourth, future research should utilize observational methods to measure children’s involvement (Miller et al, 2014; Olechnowicz, Eder, Simon, Zyzanski, & Kodish, 2002) and assess children immediately after the assent discussion, to reduce the potential effects of shared method variance and recall bias on the results.…”

Section: Research Agendamentioning

confidence: 99%

Children’s Decision-Making Involvement About Research Participation: Associations With Perceived Fairness and Self-Efficacy

Miller

Feudtner

Jawad

2017

Journal of Empirical Research on Human Research Ethics

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The primary objective of this study was to examine the associations of children’s involvement in decisions about research participation with their perceptions of the decision making process and self-efficacy. Participants were children (ages 8–17) who enrolled in research studies in the prior two months. Children completed a questionnaire that yielded three decision making involvement subscales: Researcher Engages Child; Researcher Supports Autonomy; and Child Participates. Children reported on fairness of the decision making process and health-related decision self-efficacy. After adjusting for age, higher scores on Researcher Engages Child were associated with greater self-efficacy, and higher scores on Researcher Supports Autonomy were associated with greater perceived fairness. These data underscore the potential importance of researcher-child interactions about research participation when assent is sought, including proactively involving children in the decision by asking for their opinions and communicating their central role in the decision, which are likely to be more meaningful to children than receiving information or signing a form.

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“…Prior research has found that children and adolescents with asthma are not actively involved during their medical visits [1-3]. Active involvement is important, especially for adolescents who have chronic diseases such as asthma, because interactive discussions with providers can help adolescents learn how to self-manage their treatment regimens [4].…”

Section: Introductionmentioning

confidence: 99%

Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits

Sleath

Carpenter

Davis

et al. 2017

Patient Education and Counseling

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Objective The objectives of this study were to: (a) describe teen feedback on an asthma question prompt list/video intervention designed to motivate teens to be more engaged during visits and (b) examine teen demographics associated with teen acceptance of the intervention. Methods Two hundred and fifty-nine teens ages 11 to 17 with persistent asthma were enrolled into a randomized, controlled trial and assigned to either a standard care or an intervention group where they watched an educational video with their parents and received a prompt list to complete before visits. Teens were interviewed after visits. Results Of the 185 teens randomized to the intervention group: 93% said teens should complete the prompt lists before visits; 95% recommended teens should watch the video before visits; teens with moderate/severe persistent asthma were significantly more likely to find the prompt list useful; non-White teens were significantly more likely to find the prompt list and video more useful. Conclusions Teens exposed to the question prompt list/video had very positive feedback about the intervention. Practice Implications Providers/practices should consider having teens complete question prompt lists during pre-visit wait time for use during visits and watch the video with their parents before visits.

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How do paediatricians communicate with children and parents?

Abstract: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient-centred approach.

Cited by 25 publications

References 21 publications

Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making

Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making

Children’s Decision-Making Involvement About Research Participation: Associations With Perceived Fairness and Self-Efficacy

Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits

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