Communication StudyCommunication techniques used by pediatricians during well-child program visits: A pilot study
Introduction
Pediatricians are the main formal counseling source for parents about their child's development and education [1], [2], [3]. Pediatricians’ anticipatory guidance can improve outcomes of child health and development, including: infant vocal behavior, parenting skills, infant sleep patterns, parental use of discipline, language development, prevention of falls, home accidents, and auto-passenger injuries [4].
A family's knowledge and empowerment can be improved if mothers have the opportunity to express their concerns. This has been shown to have greater predictive power than most screening tests for the detection of both developmental and child behavioral disorders [5], [6], [7], [8], [9]. If a pediatrician acknowledges maternal concerns, it could be an important contribution toward early diagnosis.
However, several studies show that parents often do not receive all the information they need [10], [11], [12], [13], [14], [15]. They do not ask the pediatrician for information about their concerns because they perceive a lack of interest or time [16], [17], [18].
Communication is an important part of a patient's experience with healthcare services and greatly affects outcomes of care [19], [20]. Despite the growing awareness of the importance of good communication in healthcare, considerable problems, such as misinformation, lack of information and lack of responsiveness are among the most often reported complaints in studies regarding patient satisfaction [21], [22], [23], [24], [25].
However, most of the studies in this field are self-reported and do not allow any inferences to be made about the quality and quantity of the communication techniques used by pediatricians. Such information would help determine how much knowledge and training is needed to improve pediatrician counseling skills and to remove counseling barriers or to reinforce appropriate counseling practices [10], [26], [27], [28], [29], [30], [31].
To study the communication flow, it is useful to divide pediatrician visits into two main parts: the exploratory portion, in which the pediatrician obtains verbal information about the parents or the child and conducts the physical examination, and the solving portion, in which the pediatrician gives and discusses information with the parent and child, as well as offers counseling. Thus, since giving and obtaining information are the main activities of the pediatrician, having a basic knowledge about the interpersonal communication process may improve essential aspects of their practice [32], [33], [34].
In order to obtain information from parents, pediatricians should combine two techniques: those aimed at obtaining concrete data (concrete data gathering) and those aimed at facilitating the parents’ expression of interest and concerns (narrative support). There are a wide range of techniques for giving information and educating patients that substantially improve understanding and help patients follow recommendations [34].
Pediatric training in Spain is primarily focused on the diagnosis and treatment of diseases. Most preventative and educational activities represent a new experience for patients. In fact, topics such as child development and education or communication techniques tend to be secondary matters in the pediatricians’ initial training [26], [35], [36].
The aim of this pilot study was to analyze communication techniques used by pediatricians during well-child program visits. The visits are used to assess overall health, development, behavior, and family functioning, as well as provide parental education through age-appropriate counseling [4], [37], [38], [39].
Section snippets
Participants
We analyzed 49 visits to 5 pediatricians in Seville (Spain) who were selected based on accessibility and professional experience. All pediatricians agreed to participate in the study. The sample is comprised of 1 male and 4 female pediatricians, with an average of 16.8 years of professional experience (SD = 9.2, min = 9, max = 32). The pediatricians’ mean age was 45.6 years (SD = 10.6, min = 34, max = 63).
The mean age of the children seen was 16.5 months (SD = 18.3, min = 0.3, max = 60). All the visits were made
Results
The average length of each pediatric visit was 16.1 min (SD = 5.6, CV = 35%, min = 6, max = 30). Significant differences among pediatricians were observed (F (4, 44) = 4.548, p = 0.004).
During the 49 visits studied, we identified 2025 communication techniques, which corresponds to 41.3 techniques per visit. In total, 59% (1201/2025) of these techniques were used to obtain information and 41% (824/2025) to inform and counsel patients.
Pediatricians obtained the majority of information through concrete data
Discussion
The average length of visit was within the recommended value [48], [49]. This information is relevant because some studies have found that longer visits were associated with greater levels of parental satisfaction [32] and a greater likelihood of discussing preventive health topics during well-child care visits [10], [11], [16].
The pediatricians in our sample used rather limited resources to get and to give information. This limitation might be caused by their understanding of interpersonal
References (49)
- et al.
Enhancing parent–provider communication in ambulatory pediatric practice
Patient Educ Couns
(2006) - et al.
Parent–provider communication and parental satisfaction with care of children with psychosocial problems
Patient Educ Couns
(2007) - et al.
The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy. A randomized controlled trial
Patient Educ Couns
(2007) - et al.
Pediatric residents’ response to ambiguous words about child discipline and behaviour
Patient Educ Couns
(2004) - et al.
Improving patients’ communication with doctors. A systematic review of intervention studies
Patient Educ Couns
(2004) The future pediatrician: promoting children's health and development
J Pediatr
(2007)- et al.
¿Qué piensan las madres sobre el programa de seguimiento de la salud infantil?
Rev Pediatr Aten Primaria
(2007) - Hidalgo MV. El proceso de convertirse en padre y madre. Análisis ecológico desde la psicología evolutiva. Tesis...
- et al.
Learning to be an American parent: How cultural models gain directive force
- et al.
Effectiveness of anticipatory guidance: recent developments
Curr Opin Pediatr
(2003)
Parents’ evaluation of developmental status: how well do parents’ concerns identify children with behavioral and emotional problems?
Clin Pediatr
A method for deciding how to respond to parent's concerns about development and behaviour
Amb Child Health
Parents’ concerns about children's development: prescreening technique or screening test?
Pediatrics
The role of parents in the detection of developmental and behavioral problems
Pediatrics
An economic analysis of developmental detection methods
Pediatrics
Overview of the content of health supervision for young children: reports from parents and pediatricians
Pediatrics
Pediatrician counseling about preventive health topics: results from the Physicians’ Practices Survey, 1998–1999
Pediatrics
Assessing health system provision of well-child care: the Promoting Healthy Development Survey
Pediatrics
Anticipatory guidance: What information do parents receive? What information do they want?
Arch Pediatr Adolesc Med
Suggestions to parents about common behavior problems in a pediatric primary care office: five years of follow-up
J Pediatr Psychol
Parental concerns about their children
J Pediatr Psychol
Determinants of counseling in primary care pediatric practice: physician attitudes about time, money and health issues
Arch Pediatr Adolesc Med
Assessing mother's attitudes about the physician's role in child health promotion
Am J Pub Health
The pediatrician as source of information about child development
J Pediatr Psychol
Cited by (15)
Communicating psychosocial problems in German well-child visits. What facilitates, what impedes pediatric exploration? A qualitative study
2014, Patient Education and CounselingCitation Excerpt :In addition, tailored training for pediatricians could help to convey the techniques of an interested focused conversational style. Generally, pediatricians seem to use a restricted range of communication techniques [39]. Evaluations of existing trainings show that promising conversational techniques can be integrated into pediatric practice [40–44].
"They just say everything's a virus"-Parent's judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: A qualitative study
2014, Patient Education and CounselingCitation Excerpt :However, a recent review found that patients’ views on doctor–patient communication in primary care are relatively under researched [20]. Studies have found that pediatricians use only a limited range of communication techniques in consultations [21] and that communication varies considerably between clinicians [21] and between consultations for different types of medical problems [22,23]. A recent study focused on parents’ acceptance of antibiotic prescribing decisions for children with RTI and found that trust, open communication and continuity of care played a key role [24].
Exploring caregiver understanding of medications immediately after a pediatric primary care visit
2013, Patient Education and CounselingCitation Excerpt :Addressing communication to reduce error, is supported by Kaushal's finding that 54% of the ADE's at their outpatient centers were ameliorable, resulting from inadequate communication [2]. Currently, pediatricians’ have varying communication styles and skills [32], and report a low rate of using enhanced communication techniques recommended by health literacy experts, despite being aware of instances of parental misunderstanding and/or a communication-related error in patient care [33]. As the medical system struggles to address medication errors, there are many possible interventions to consider and the answer will likely require a combination of approaches.
What do paediatricians and mothers talk about in the well-child program visits?
2011, Anales de PediatriaProfessional Skills in Family Support: A Systematic Review
2024, Social Sciences