How do paediatricians communicate with children and parents?

Abstract

Aim: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor‐parent‐child communication in the outpatient setting. Methods: Fifty‐one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. Results: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). Control: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor. Conclusion: 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.

Triadic communication in the primary care paediatric consultation: a review of the literature

“…21 Interestingly, two of the studies showed that when the children did speak more in the consultations, the consultations were not longer, rather the child took up the adult's discourse space. 31,36 Limitations of studies included in the review A number of methodological limitations were identified in the studies found for this review.…”

“…[18][19][20][21]24,26,29,31,36 These studies use different methods to reach these estimates and so are not directly comparable with one another. However, they do show that the child has a limited quantifiable involvement in their own consultation.…”

“…This part takes place between the adults, with this distribution of child involvement seen in all the studies that reported this information. 19,21,[23][24][25][26]31,36 When a child was asked to present the problem for attendance, one of the studies suggested that this gave a child more opportunity to go on to have some participation in the latter part of the consultation. 23 It has also been shown that if the doctor and child start talking together at the outset of the consultation without the adult carer having had their concerns expressed, this is likely to result in the adult interrupting doctor-child talk.…”

“…[18][19][20][21][22][23][24][25] Thirteen papers on the paediatric triadic consultation in settings outside primary care, which met the criteria for inclusion, were found as shown in Table 2. [26][27][28][29][30][31][32][33][34][35][36][37][38] They are diverse in terms of the methodology used to evaluate the consultations, settings, and study designs. Eleven quantitative studies, nine qualitative studies, and one literature review of triadic paediatric consultation were found.…”

Effects of pre-consultation lists on the communicative behavior of children with cancer and their caregivers

“…Health communication may be perceived as a relational process of exchanging information and its understanding between at least two people, including contextual variables and individual characteristics (Araújo & Cardoso, 2007;Arora, 2003;Fisher & Broome, 2011;Wassmer et al, 2004). In some cases of health services, such as pediatric assistance, communication occurs necessarily between the health professional, patient and caregiver, a triadic interaction that requires specific abilities from pediatricians (Gabe, Olumide, & Bury, 2004;Howells, Davies, & Silverman, 2006;Howells & Lopez, 2008;McGraw et al, 2012;Nobile & Drotar, 2003;Tates & Meeuwesen, 2001).…”