Correlates of type and quantity of child communication during pediatric subspecialty encounters

Area of Science:

• Pediatric Subspecialty Care
• Child Communication in Healthcare Settings
• Shared Decision-Making in Chronic Disease Management

Background:

• Understanding child communication is crucial for shared decision-making in pediatric chronic disease management.
• Previous research indicates limited child participation in primary care settings.
• The extent and nature of child communication in subspecialty clinics remain less understood.

Purpose of the Study:

• To quantify and qualify child communication during outpatient pediatric subspecialty encounters.
• To investigate variations in child communication based on demographics and visit characteristics.

Main Methods:

• Videotaped encounters involving 20 healthcare providers and 155 children with conditions including leukemia, asthma, cystic fibrosis, type 1 diabetes, and obesity.
• Utilized the Roter Interaction Analysis System to categorize child utterances.
• Analyzed communication patterns across different subspecialty clinics.

Main Results:

• Children contributed a mean of 15% of all utterances during the observed clinical encounters.
• A higher proportion of child utterances was observed during encounters for obesity compared to other conditions.
• Most child utterances were reactive, primarily serving as responses to adult-initiated questions.

Conclusions:

• Children's participation in subspecialty visits is limited, mirroring patterns seen in primary care.
• Engagement was notably higher in obesity clinics, particularly concerning lifestyle choices.
• Effective communication strategies from obesity clinics may be transferable to enhance child engagement in other pediatric subspecialties.