To give the invisible child priority: Children as next of kin in general practice

Abstract

Objective. To explore general practitioners’ (GPs’) experiences in helping children as next of kin of drug-addicted, mentally ill, or severely somatic ill adults. These children are at risk of long-term mental and somatic health problems. Design. Qualitative focus-group study. Setting. Focus-group interviews were conducted in western Norway with a total of 27 GPs. Participants were encouraged to share stories from clinical encounters with parents who had one of the above-mentioned problems and to discuss the GP's role in relation to helping the patients’ children. Results. The GPs brought up many examples of how they could aid children as next of kin, including identifying children at risk, counselling the parents, and taking part in collaboration with other healthcare professionals and social workers. They also experienced some barriers in fulfilling their potential. There were time constraints, the GPs had their main focus on the patient present in a consultation, and the child was often outside the attention of the doctors, or the GPs could be afraid of hurting or losing their vulnerable patients, thus avoiding bringing up the patients’ children as a subject for discussion. Conclusions. Norwegian GPs are in a good position to help children as next of kin and doctors make a great effort to support many of them. Still, support of these children by GPs often seems to depend not on careful consideration of what is best for the patient and the child in the long run, but more on short-term convenience reasons.

Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study

“…Thus, it is important that the GP take the first step to bring up the topic when appropriate. In an interview study we performed with GPs, they spoke about the barriers against bringing up this topic [14]. Professionals’ resistance against introducing the theme about how the children are doing is also documented in other studies [24, 43].…”

“…GPs participating in a previous study [14] and GPs in our professional network were asked to recruit patients to the study. The GPs received invitation letters for patients with information and reply forms.…”

“…Children of seriously ill parents are at risk of developing their own psychosocial and health problems [10–12]. Hence, children and families at risk should be identified so their needs can be recognized and support can be ensured [13, 14]. There seems to be a knowledge gap regarding factors that may facilitate ill parents seeking help and advice for their parental role in a strained situation.…”

“…The point of departure for the GP who is engaged in the children’s situation is to address the children’s special needs with the parents, and eventually get the parents’ consent to initiate specific follow-up. However, studies have shown that often there are barriers for health personnel to implement this, both in general practice and in hospitals [14, 23, 24]. GPs who considered these children as their responsibility still reported that they either forgot to address the children’s needs, or they were afraid of hurting their vulnerable patients, and possibly increase the parent’s feeling of guilt and shame [14].…”

“…However, studies have shown that often there are barriers for health personnel to implement this, both in general practice and in hospitals [14, 23, 24]. GPs who considered these children as their responsibility still reported that they either forgot to address the children’s needs, or they were afraid of hurting their vulnerable patients, and possibly increase the parent’s feeling of guilt and shame [14]. Thus, it may be challenging for GPs to address the children’s situation in encounters with their parents.…”