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Guttmann KF, Raviv GN, Fortney CA, Ramirez M, Smith CB. Parent Perspectives on Communication Quality in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:382-388. [PMID: 38975667 PMCID: PMC11334642 DOI: 10.1097/anc.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking. PURPOSE We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences. METHODS We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke. RESULTS Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course. IMPLICATIONS FOR PRACTICE AND RESEARCH We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Guttmann and Ms Raviv); The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio (Dr Fortney); Research Division, Hebrew Home at Riverdale, Riverdale, New York, USA (Dr Ramirez); Division of Hematology and Medical Oncology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith); Brookdale Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith and Dr Guttmann)
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Meyer SB, Brown P, Calnan M, Ward PR, Little J, Betini GS, Perlman CM, Burns KE, Filice E. Development and validation of the Trust in Multidimensional Healthcare Systems Scale (TIMHSS). Int J Equity Health 2024; 23:94. [PMID: 38720303 PMCID: PMC11078716 DOI: 10.1186/s12939-024-02162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
CONTEXT The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. METHODS We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). FINDINGS We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. CONCLUSIONS This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.
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Affiliation(s)
- Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
| | - Patrick Brown
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Calnan
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Paul R Ward
- Centre for Public Health, Equity & Human Flourishing, Torrens University, Adelaide, Australia
| | - Jerrica Little
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Kathleen E Burns
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
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Sisk BA, Newman AR, Chen D, Mack JW, Reeve BB. Designing and validating novel communication measures for pediatric, adolescent, and young adult oncology care and research: The PedCOM measures. Pediatr Blood Cancer 2023; 70:e30685. [PMID: 37740578 DOI: 10.1002/pbc.30685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND High-quality communication in pediatric and adolescent cancer is the standard of care. Yet, we lack pediatric-specific communication measures. We designed self-report and caregiver-report communication measures for use in pediatric oncology settings. METHODS We recruited adolescent and young adults (AYAs; 12-24 years) with cancer and parents of children and AYAs between 1 month post-diagnosis and 2 months after completing treatment. Participants completed measures including 58 questions addressing eight previously characterized communication functions. For each function, we conducted factor analysis, and assessed reliability and construct validity. Based on psychometric properties, we created final long-form (31 items) and short-form (eight items) communication measures (PedCOM) for both self- and caregiver-report. RESULTS Participants included 200 parents and 88 AYAs. The final 31-item and eight-item PedCOM measures for parents and AYAs demonstrated good unidimensional model fit. Each communication function (e.g., building relationships) demonstrated high reliability, coefficient alphas ranged from .83 to .93 for parents and .85 to .93 for AYAs. The overall 31-item and eight-item PedCOM measures also demonstrated high reliability (alphas >.9). For construct validity, PedCOM-Parent-31 and PedCOM-Parent-8 correlated positively with satisfaction with care, trust, emotional self-management, and decisional satisfaction, and negatively with anxiety and caregiver burden. PedCOM-AYA-31 and PedCOM-AYA-8 correlated positively with satisfaction with care, trust, emotional self-management, symptoms self-management, and decisional satisfaction, and negatively with anxiety. DISCUSSION We developed valid and reliable measures of communication functions for parents and AYAs with cancer. These measures can support organizations and stakeholder groups that are striving to improve the quality of cancer care.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics and Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amy R Newman
- Marquette University, Milwaukee, Wisconsin, USA
- Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Dandan Chen
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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MERENSTEIN ZACHARY, SHUEMAKER JILLC, PHILLIPS ROBERTL. Measuring Trust in Primary Care. Milbank Q 2023; 101:841-880. [PMID: 37167452 PMCID: PMC10509519 DOI: 10.1111/1468-0009.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Policy Points Trust in primary care clinicians is essential for effective patient care and is associated with better health outcomes, but it is rarely assessed, and existing measures have not been thoroughly evaluated. This scoping review reveals that research assessing patients' trust in primary care clinicians largely stopped more than a decade ago but offers candidate measures for future testing, implementation, and policy applications. CONTEXT Trust is a fundamental aspect of any human relationship, and medical care is no exception. An ongoing, trusting relationship between clinicians and patients has shown demonstrable value to primary care. However, there is currently no measure of trust in general use, and none endorsed for use by most value-based payment programs. This review searched the literature for any existing measures of patient trust in primary care clinicians and assessed their potential to be implemented as a patient-reported outcome measure. METHODS A keyword search on PubMed along with scanning references was conducted to find any trust measures in health care. Measures that did not address primary care clinicians were eliminated and the remaining measures were then assessed for their utility to primary care. RESULTS This purposeful, scoping review found four tested measures for assessing patients' trust in primary care clinicians that are candidates for general use. Of these four, the revised Trust in Physicians Scale and Wake Forest Physician Trust Scale are the most tested and viable options. CONCLUSION Renewed national interest in trust in health care should focus on the capacity to measure it. This review informs the effort to test trust measures for use in research, practice improvement, and value-based payment. Measuring trust, how it relates to outcomes, and learning how it is produced or lost are key to assisting practices and health systems toward earning it.
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Affiliation(s)
| | - JILL C. SHUEMAKER
- American Board of Family Medicine Foundation, The Center for Professionalism & Value in Health Care
| | - ROBERT L. PHILLIPS
- American Board of Family Medicine Foundation, The Center for Professionalism & Value in Health Care
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Krüger K, Lapstich AM, Reber KC, Sehlen S, Liersch S, Krauth C. Determinants for participation in a prevention and early detection programme for children and adolescents in Germany: does social background play a role? Arch Public Health 2023; 81:163. [PMID: 37644482 PMCID: PMC10463933 DOI: 10.1186/s13690-023-01173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Early detection examinations and prevention are particularly important in childhood and adolescence, as certain diseases are already developing and health-related attitudes and behaviour patterns are formed and implemented. Despite the importance of screening and prevention, not all families use the available services and programmes. The aim of this study is to identify factors associated with participation in an early detection and prevention programme for children and adolescents, as well as factors associated with actual uptake of an examination. The analyses are based on questionnaire data of an online survey of participants and non-participants. Descriptive analyses and logistic regression models are conducted on a defined sample (n = 1,289). The results show that both groups differ with regard to several factors: age, chronic diseases, federal state, living space, number of siblings, country of birth, migration background, language spoken at home, mother's occupational status, household income, treatment duration, and trust in treating physician. Regression I shows that participation in the programme is significantly associated with higher age, language spoken at home, mother's occupational status and greater trust in the treating physician. The latter demonstrates the highest predictive power. Regression II indicates that the actual uptake of an examination among participants is significantly affected by age, federal state and father's occupational status. Overall, the results of this study show that social background partly plays a role in participation, but that factors such as trust in the treating physician also have a significant impact. For the future, further research on the factors influencing participation in screening and prevention services or programmes for children and adolescents is important in order to develop strategies to overcome existing barriers and thus reach groups that have not been reached yet. In this context, trust in the treating physician and his or her influence on decision-making should in particular be considered.
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Affiliation(s)
- Kathrin Krüger
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany.
| | - Anne-Marie Lapstich
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany
| | - Katrin Christiane Reber
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Stephanie Sehlen
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Sebastian Liersch
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Christian Krauth
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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Serhan O, Moise A, Guadagno E, Issa AM, Poenaru D. Exploring trust development in families of children towards surgical and emergency care providers: A scoping review of the literature. J Pediatr Surg 2023; 58:871-878. [PMID: 36797110 DOI: 10.1016/j.jpedsurg.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Trust is central to the therapeutic relationship between patients and their providers, yet little is known about how it is developed in the unique context of children facing surgical emergencies. We sought to identify factors fostering trust development, gaps, and areas for improvement. METHODS We searched eight databases from inception to June 2021 to identify studies focusing on trust in pediatric surgical and urgent care settings. PRISMA-ScR protocols were followed, and screening carried out by two independent reviewers. Data collection included study characteristics, outcomes, and results. RESULTS Out of 5578 articles screened, 12 fulfilled the inclusion criteria. Four major trust constructs were identified: competence, communication, dependability, and caring. Despite various instruments used, all studies reported a high level of parental trust. Nearly all studies (11/12) noted trust depending on parents' sociodemographic background, with ethnicity (3/12) and level of education and language barriers (2/12) limiting parents' confidence in physicians. High trust levels significantly correlated with effective communication and perceived quality of care. Most effective interventions enhancing trust included communication and caring trust constructs (10/12) rather than competence and dependability (5/12). Parents' individual experiences, development of compassionate interactions, and practice of family-centered care appeared important in developing trust. CONCLUSIONS Improving communication and providing compassionate care, as well as encouraging a patient-centered approach, appear to be most effective in promoting trust in pediatric surgical and urgent settings. Our findings can guide future educational interventions towards strengthening parental trust and promoting child- and family-centered care in pediatric surgical settings.
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Affiliation(s)
- Olivia Serhan
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.
| | - Alexander Moise
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Amalia M Issa
- Dept of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Dan Poenaru
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
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Cooper JN, Koppera S, Bliss AJ, Lind MN. Characteristics associated with caregiver willingness to consider tonsillectomy for a child's obstructive sleep disordered breathing: Findings from a survey of families in an urban primary care network. Int J Pediatr Otorhinolaryngol 2022; 158:111143. [PMID: 35552164 DOI: 10.1016/j.ijporl.2022.111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Tonsillectomy use is lower among Black children than White children in the U.S. despite their higher prevalence of obstructive sleep disordered breathing (oSDB). We aimed to identify factors associated with parents' willingness to consider tonsillectomy for their child's oSDB and to identify whether parents of Black children are less willing than parents of non-Black children to be willing to consider the procedure. STUDY DESIGN Prospective cohort study. SETTING Primary care network of a tertiary children's hospital. METHODS We surveyed parents/guardians of children aged 2-10 years with oSDB, to assess their knowledge about oSDB and tonsillectomy, perceived severity of their child's oSDB, perceived level of their child's sleep disturbance, perceived risks and benefits of tonsillectomy, stress, trust in their child's primary care physician and physicians in general, and health literacy. We also assessed child clinical and sociodemographic characteristics. Associations between these characteristics and parent/guardian willingness to consider tonsillectomy for their child's oSDB were assessed. RESULTS Of the 59 parents/guardians included, 90% were mothers and 71% were Black. Only 58% of caregivers of Black children but 85% of caregivers of non-Black children were willing to consider tonsillectomy (p = 0.04). Caregivers with another child who had undergone tonsillectomy and caregivers who perceived their child's sleep to be more disturbed were more often willing to consider tonsillectomy (both p = 0.02). CONCLUSIONS Parents of Black children are less willing to consider tonsillectomy for their child's oSDB, but this was not explained by any factors assessed in this study. Future studies should evaluate additional factors that may explain this difference and that might be targeted to ensure appropriate and equitable access to tonsillectomy among children with oSDB.
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Affiliation(s)
- Jennifer N Cooper
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra J Bliss
- Medical Student Research Program, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, OH, USA
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Madrigal VN, Hill DL, Shults J, Feudtner C. Trust in Physicians, Anxiety and Depression, and Decision-Making Preferences among Parents of Children with Serious Illness. J Palliat Med 2022; 25:428-436. [PMID: 34516933 PMCID: PMC8968833 DOI: 10.1089/jpm.2021.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To assess parental decision-making preferences when caring for a child with serious illness and to evaluate for an association between preferences and parental trust in physicians, and potential modification of this association by parental anxiety or depression. Methods: We analyzed cross-sectional data from 200 parents of 158 children in the United States who had life-threatening illnesses and whose attending physicians thought that the parents would have to make major medical decision in the next 12 to 24 months. Parents completed measures of decision-making preferences, trust in physicians, anxiety, and depression. Results: Higher reported levels of trust were associated with lower preferences for autonomous decision making (Spearman correlation = -0.24; 95% confidence interval [CI] = -0.36 to -0.01; p < 0.008). Among parents with higher levels of trust, increasing anxiety scores were associated with decreasing preference for autonomy, whereas among parents with lower levels of trust, increasing anxiety scores showed an increasing preference for autonomy (regression coefficient = -0.01; 95% CI = -0.02 to -0.001; p ≤ 0.03). Conclusions: Decreasing trust in physicians is associated with a higher preference for autonomous decision making. Parents who have higher levels of anxiety exhibit this association more strongly. Decision support for parents of children with serious illness should use strategies to respect parental decision-making preferences, address potential distrust, and provide mental health support to parents who are anxious or depressed.
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Affiliation(s)
- Vanessa N. Madrigal
- Division Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.,Pediatric Ethics Program, Children's National Hospital, Washington, DC, USA
| | - Douglas L. Hill
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Department of Biostatistics, Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Chris Feudtner, MD, PhD, MPH, Department of Medical Ethics, Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA
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Foot E, Leonhard A, Majeski J, Zahn L, Li HH, Caruso Brown AE. "The stakes could not be higher": A mixed methods study of parental social media use in pediatric oncology. Pediatr Blood Cancer 2021; 68:e29176. [PMID: 34133056 DOI: 10.1002/pbc.29176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/02/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists' advice and information found on SM. PROCEDURE Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child's health were recruited through SM sites and nonprofit organizations across the United States and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. RESULTS Ninety parents completed written questionnaires; 21 completed follow-up interviews. Seventy percent reported experiencing a situation in which information shared on SM conflicted with information provided by their child's oncologist. Although 86% reported that they discussed the conflicting information with the oncologist and 70% described the oncologist's response as positive, 78% also described ongoing negative feelings about the experience. Parents described openness to discussing SM, honesty, transparency, and humility regarding the limits of medicine, and shared decision-making regarding information found on SM as increasing their trust in their oncologist. CONCLUSIONS Parents offered valuable insights regarding their experiences navigating SM, including eight recommendations for how pediatricians might approach discussing parental SM use. Future studies will evaluate the utility of these recommendations for pediatric clinicians.
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Affiliation(s)
| | | | - Jill Majeski
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lauren Zahn
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Hsin H Li
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amy E Caruso Brown
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York, USA.,Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
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11
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Rotaru TȘ, Frățilă OC, Bărboi O, Ciortescu I, Mihai C, Anton C, Ștefănescu G, Drug V. A comparison using standardized measures for patients with irritable bowel syndrome: Trust in the gastroenterologist and reliance on the internet. Neurogastroenterol Motil 2021; 33:e13977. [PMID: 32875697 DOI: 10.1111/nmo.13977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) patients' use of the Internet for health information interacts with the way they trust their gastroenterologist. No standardized measure has targeted IBS patients and gastroenterologists specifically, nor their use of the Internet. The aims of this paper were as follows: the development of a scale that measures an IBS patient's trust in their gastroenterologist, the development of a scale measuring an IBS patient's reliance on Internet health information, and testing the hypothesis that IBS patients, who use the Internet for IBS-related information, trust their gastroenterologist less than those who do not. METHOD A total of 82 patients (mean age 49, SD = 14.62) diagnosed with IBS completed two questionnaires: one about trust in their gastroenterologist and the other about the reliance on Internet health information regarding IBS. The two questionnaires were built using current literature as well as our previous qualitative research. The statistical computations were performed using the SPSS 20 program. KEY RESULTS Both questionnaires proved to be reliable in measuring gastroenterologist-IBS patient trust (alpha = 0.87) and Internet information reliance (alpha = 0.88), respectively. The IBS patients who did not look for information about IBS over the Internet had significantly higher trust in their gastroenterologist compared with those who did (U = 535.5; z = -2.26; P < 0.05). CONCLUSIONS We developed two ready-to-use scales to measure both the gastroenterologist-IBS patient's trust and the IBS patient's reliance on the Internet. Further studies will be able to explore the interaction among all variables in IBS patients' trust.
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Affiliation(s)
| | | | - Oana Bărboi
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Irina Ciortescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Cătălina Mihai
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Carmen Anton
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Gabriela Ștefănescu
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
| | - Vasile Drug
- University of Medicine and Pharmacy «Gr. T. Popa» Iași, Iași, Romania.,Institute of Gastroenterology and Hepatology, University Hospital St Spiridon, Iași, Romania
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Suttle M, Hall MW, Pollack MM, Berg RA, McQuillen PS, Mourani PM, Sapru A, Carcillo JA, Startup E, Holubkov R, Dean JM, Notterman DA, Meert KL. Therapeutic Alliance Between Bereaved Parents and Physicians in the PICU. Pediatr Crit Care Med 2021; 22:e243-e252. [PMID: 33044415 PMCID: PMC8016694 DOI: 10.1097/pcc.0000000000002585] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Therapeutic alliance is the collaborative bond that develops between patients/families and healthcare providers. Our objective is to determine the extent of therapeutic alliance bereaved parents perceive to have occurred with their child's physicians during their child's PICU stay, and associated factors. DESIGN Multicenter observational study. SETTING Eight children's hospitals affiliated with the Collaborative Pediatric Critical Care Research Network. PATIENTS Parents greater than or equal to 18 years old whose child died in a PICU (including cardiac ICU). INTERVENTIONS Bereaved parents completed the Human Connection Scale, a 16-item measure of therapeutic alliance, 6 months after their child's death. Human Connection Scale scores range from 16 to 64 with higher scores indicating greater alliance. Parents provided sociodemographic data, and medical records were reviewed for the child's clinical characteristics. MEASUREMENTS AND MAIN RESULTS Two-hundred and thirty-three parents of 157 deceased children responded to the Human Connection Scale with greater than or equal to 80% item completion. Among parents, 146 (62.7%) were female, 155 (66.5%) were White and 46 (19.7%) were Black, 175 (75.1%) were married, and 209 (89.7%) had at least a high-school education. Among children, median age at the time of death was 5.9 years (interquartile range, 0.64-13.9 yr) and 114 (72.6%) died after limitation or withdrawal of life support. Mean Human Connection Scale score was 51.4 ± 11.1 for all parents, 52.6 ± 9.0 for White parents, and 47.0 ± 13.7 for Black parents. In multivariable modeling predicting Human Connection Scale scores, race was the only parent or child characteristic in the final model. Human Connection Scale scores were significantly different (-4.56; 95% CI, -8.53 to -0.6; p = 0.025) between the Black and White parents with items about trust, care, and honest communication showing the greatest mean difference. CONCLUSIONS Among parents bereaved in the PICU, therapeutic alliance with physicians is moderately high. Future research should identify strategies to strengthen therapeutic alliance with Black parents and examine the role of alliance on bereaved parents' health outcomes.
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Affiliation(s)
- Markita Suttle
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Mark W. Hall
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Murray M. Pollack
- Department of Pediatrics, Children’s National Hospital, Washington DC
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Patrick S. McQuillen
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA
| | - Peter M. Mourani
- Department of Pediatrics, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anil Sapru
- Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Emily Startup
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Kathleen L. Meert
- Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, MI
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Pham T, Kuznetsova A, Gim H, Cordrey K, Milanaik R. The Internet's Effect on Parental Trust in Pediatrician Diagnosis of Autism and Likelihood of Seeking a Second Opinion. J Autism Dev Disord 2019; 49:4355-4362. [PMID: 31317368 DOI: 10.1007/s10803-019-04140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study assessed how web-based information affects parental trust in physician's diagnosis of autism (PDA) and likelihood of seeking a second opinion. Participants of an online survey were randomly allocated to one of three hypothetical scenarios, all were given a vignette of a non-verbal 18-month-old child followed by (1) not viewing Internet results, (2) viewing results suggesting autism, or (3) viewing results suggesting language delay and rated their trust and likelihood of seeking a second opinion. When Internet results contradicted PDA, parents reported less trust in PDA and greater likelihood of seeking a second opinion. Due to the Internet's influence on parents' response to PDA, clinicians should discuss their differential diagnosis with parents, address Internet-related concerns, and recommend trustworthy sources.
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Affiliation(s)
- Tammy Pham
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Anna Kuznetsova
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Haelynn Gim
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Kyla Cordrey
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Ruth Milanaik
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA.
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14
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Hess EP, Homme JL, Kharbanda AB, Tzimenatos L, Louie JP, Cohen DM, Nigrovic LE, Westphal JJ, Shah ND, Inselman J, Ferrara MJ, Herrin J, Montori VM, Kuppermann N. Effect of the Head Computed Tomography Choice Decision Aid in Parents of Children With Minor Head Trauma: A Cluster Randomized Trial. JAMA Netw Open 2018; 1:e182430. [PMID: 30646167 PMCID: PMC6324506 DOI: 10.1001/jamanetworkopen.2018.2430] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Pediatric Emergency Care Applied Research Network prediction rules for minor head trauma identify children at very low, intermediate, and high risk of clinically important traumatic brain injuries (ciTBIs) and recommend no computed tomography (CT) for those at very low risk. However, the prediction rules provide little guidance in the choice of home observation or CT in children at intermediate risk for ciTBI. OBJECTIVE To compare a decision aid with usual care in parents of children at intermediate risk for ciTBI. DESIGN, SETTINGS, AND PARTICIPANTS This cluster randomized trial was conducted in 7 geographically diverse US emergency departments (EDs) from April 1, 2014, to September 30, 2016. Eligible participants were emergency clinicians, children ages 2 to 18 years with minor head trauma at intermediate risk for ciTBI, and their parents. INTERVENTIONS Clinicians were randomly assigned (1:1 ratio) to shared decision-making facilitated by the Head CT Choice decision aid or to usual care. MAIN OUTCOMES AND MEASURES The primary outcome, selected by parent stakeholders, was knowledge of their child's risk for ciTBI and the available diagnostic options. Secondary outcomes included decisional conflict, parental involvement in decision-making, the ED CT rate, 7-day health care utilization, and missed ciTBI. RESULTS A total of 172 clinicians caring for 971 children (493 decision aid; 478 usual care) with minor head trauma at intermediate risk for ciTBI were enrolled. The patient mean (SD) age was 6.7 (7.1) years, 575 (59%) were male, and 253 (26%) were of nonwhite race. Parents in the decision aid arm compared with the usual care arm had greater knowledge (mean [SD] questions correct: 6.2 [2.0] vs 5.3 [2.0]; mean difference, 0.9; 95% CI, 0.6-1.3), had less decisional conflict (mean [SD] decisional conflict score, 14.8 [15.5] vs 19.2 [16.6]; mean difference, -4.4; 95% CI, -7.3 to -2.4), and were more involved in CT decision-making (observing patient involvement [OPTION] scores: mean [SD], 25.0 [8.5] vs 13.3 [6.5]; mean difference, 11.7; 95% CI, 9.6-13.9). Although the ED CT rate did not significantly differ (decision aid, 22% vs usual care, 24%; odds ratio, 0.81; 95% CI, 0.51-1.27), the mean number of imaging tests was lower in the decision aid arm 7 days after injury. No child had a missed ciTBI. CONCLUSIONS AND RELEVANCE Use of a decision aid in parents of children at intermediate risk of ciTBI increased parent knowledge, decreased decisional conflict, and increased involvement in decision-making. The intervention did not significantly reduce the ED CT rate but safely decreased health care utilization 7 days after injury. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02063087.
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Affiliation(s)
- Erik P. Hess
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James L. Homme
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Anupam B. Kharbanda
- Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis
| | | | - Jeffrey P. Louie
- Division of Emergency Medicine, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lise E. Nigrovic
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Nilay D. Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, Minnesota
| | - Jonathan Inselman
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, Minnesota
| | - Michael J. Ferrara
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jeph Herrin
- Yale University School of Medicine, New Haven, Connecticut
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nathan Kuppermann
- Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento
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15
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Freed GL, Spike N, O'Hara J, Hiscock H, Rhodes AL. National study of parental confidence in general practitioners. J Paediatr Child Health 2018; 54:127-131. [PMID: 28868733 DOI: 10.1111/jpc.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/28/2022]
Abstract
AIM To assess a national sample of Australian parental confidence in general practitioner (GP) care for illness and injury for their children. METHODS Cross-sectional, internet-based survey of a national, representative sample of parents of children birth - 17 years in Australia was used. Purposeful recruitment was used to achieve a national, representative sample of 2100 Australian parents, reflective of demographic and geographic distribution based on census data. Parents were asked to indicate their degree of confidence in a GP to handle medical problems as well as their preference for, and use of, paediatric speciality care for their children. RESULTS Fewer than half of parents (44%) reported that they were completely confident in a GP to provide general care as defined as 'can handle almost all general health issues for my child'. A slightly greater proportion of parents (56%) were completely confident in a GP to provide care for minor injuries, defined as injuries not requiring an X-ray. Greater confidence in general care was seen among parents >40 years of age and those whose GP is always bulk billed. CONCLUSIONS Parental confidence in GPs is an important issue. Our findings that fewer than half of parents are completely confident in their GP to provide general care to their child may be an influencing factor on current health-care utilisation trends. The potential implications of low parental confidence in GPs are greater numbers of emergency department presentations for children with lower urgency conditions and increased referrals of children for specialty care.
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Affiliation(s)
- Gary L Freed
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Spike
- Victorian Metropolitan Alliance, Melbourne, Victoria, Australia
| | | | - Harriet Hiscock
- Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anthea L Rhodes
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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16
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Alpern AN, Gardner M, Kogan B, Sandberg DE, Quittner AL. Development of Health-Related Quality of Life Instruments for Young Children With Disorders of Sex Development (DSD) and Their Parents. J Pediatr Psychol 2017; 42:544-558. [PMID: 27026663 DOI: 10.1093/jpepsy/jsw022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/01/2016] [Indexed: 11/13/2022] Open
Abstract
Objective Research in disorders of sex development (DSD) is hindered by a lack of standardized measures sensitive to the experiences of affected children and families. We developed and evaluated parent proxy (children 2-6 years) and parent self-report (children ≤6 years) health-related quality of life (HRQoL) instruments for DSD. Methods Items were derived from focus groups and open-ended interviews. Clarity and comprehensiveness were assessed with cognitive interviews. Psychometric properties were examined in a field survey of 94 families. Results Measures demonstrated adequate to good psychometrics, including internal consistency, test-retest reliability, convergent validity, and ability to detect known-group differences. Parents reported greatest stress on Early Experiences , Surgery , and Future Concerns scales. Conclusions These instruments identify patients' and families' needs, monitor health and quality of life status, and can evaluate clinical interventions. Findings highlight the need for improved psychosocial support during the diagnostic period, better parent-provider communication, and shared decision-making. HRQoL measures are needed for older youth.
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Affiliation(s)
- Adrianne N Alpern
- Department of Psychology, University of Miami, Ponce De Leon Blvd., Coral Gables, FL, USA
| | - Melissa Gardner
- Department of Pediatrics; Division of Pediatric Psychology and Child Health Evaluation & Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan, USA
| | - Barry Kogan
- Division of Urology, Albany Medical College, Albany, NY, USA
| | - David E Sandberg
- Department of Pediatrics; Division of Pediatric Psychology and Child Health Evaluation & Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra L Quittner
- Department of Psychology, University of Miami, Ponce De Leon Blvd., Coral Gables, FL, USA
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17
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Hwang SS, Rybin DV, Heeren TC, Colson ER, Corwin MJ. Trust in Sources of Advice about Infant Care Practices: The SAFE Study. Matern Child Health J 2017; 20:1956-64. [PMID: 27129949 DOI: 10.1007/s10995-016-2011-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado, 13121 E. 17th Street, Mailstop 8402, Aurora, CO, 80045, USA. .,Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Timothy C Heeren
- Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Eve R Colson
- Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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18
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Hwang SS, Rybin DV, Kerr SM, Heeren TC, Colson ER, Corwin MJ. Predictors of Maternal Trust in Doctors About Advice on Infant Care Practices: The SAFE Study. Acad Pediatr 2017; 17:762-769. [PMID: 28315416 DOI: 10.1016/j.acap.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine predictors of maternal trust in doctors about advice on infant care practices. METHODS Using probability sampling methods, we recruited mothers from 32 US maternity hospitals. Mothers completed a survey 2 to 6 months postpartum that included questions about maternal trust in doctors regarding 6 infant care practices and physician characteristics (doctor asked mother's opinion, doctor is qualified, infant sees 1 main doctor who is/is not of the same ethnicity/race). Prevalence estimates and 95% confidence intervals were calculated for maternal trust in physician advice for each infant care practice. Multivariate logistic regression was used to calculate the independent association of maternal and physician characteristics and trust for each infant care practice, controlling for sociodemographic characteristics. RESULTS Of the 3983 mothers enrolled from January 2011 to March 2014, 3297 (83%) completed the follow-up survey. Maternal trust in the doctor varied according to infant care practice with highest trust for vaccination (89%) and lowest trust for pacifier use (56%). In the adjusted analyses, for all infant care practices, mothers were more likely to trust their doctors if they reported that the doctors were qualified (adjusted odds ratio [AOR], >3.0 for all practices) or if the doctor had asked their opinion (AOR, 1.76-2.43). For mothers who reported seeing 1 main doctor, white mothers were more likely to trust physicians for almost all infant care practices if they reported the doctor was the same race (AOR, 1.54-2.19). CONCLUSIONS Physician characteristics and ways of communication were significantly associated with maternal trust in doctors about advice on infant care practices.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Children's Hospital Colorado, Aurora; Pediatrics, University of Colorado School of Medicine, Aurora.
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Mass
| | - Stephen M Kerr
- Data Coordinating Center, Boston University School of Public Health, Mass; Slone Epidemiology Center, Boston University, Mass
| | | | - Eve R Colson
- Pediatrics, Yale University School of Medicine, New Haven, Conn
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Trust in the Medical Profession Among Adolescents in an Emergency Department. Pediatr Emerg Care 2017; 36:e125-e128. [PMID: 28509687 PMCID: PMC6023780 DOI: 10.1097/pec.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to assess trust in the medical profession among adolescents in an urban pediatric emergency department (ED) and explore factors associated with trust. METHODS We used a computerized survey to assess personal trust, perceived trust among family/friends, health care use, general and genital examination preferences, health behaviors, and demographics among youth aged 14 to 19 years. The primary outcome was the mean composite score of a validated 5-item scale. Responses were summed (range, 5-25); higher scores indicated greater trust. We compared trust between subgroups using the t test for independent samples. RESULTS We enrolled 150 adolescents (80% of approached); 146 completed the survey (mean age, 15.6 y; 40% male; 36% African American, 40% white, 17% Hispanic; 29% commercial insurance). The mean trust score was 19.51 ± 3.1 (range, 7-25), indicating a fairly high level of trust. Trust was not associated with race, ethnicity, sex, type of insurance, or health care use. The mean score for those with high paternal trust was higher than those reporting low paternal trust (19.8 ± 2.2 vs 15.3 ± 5.7, P = 0.02); there was no association with perceived trust among mothers or friends. Preference for a chaperoned genital examination was associated with lower trust and female sex. CONCLUSIONS Adolescents in this ED reported high levels of trust in the medical profession, and trust was not associated with race, ethnicity, sex, insurance, or health care use. Youth with lower trust preferred chaperoned genital examinations. Adolescent trust may be influenced by perceived trust among important adults. Exploration of these associations seems warranted to facilitate optimal sexual health outcomes.
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Kohlsdorf M, Costa Junior ÁL. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology. PSICOLOGIA-REFLEXAO E CRITICA 2016. [DOI: 10.1186/s41155-016-0028-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Larson JJ, Lynch S, Tarver LB, Mitchell L, Frosch E, Solomon B. Do Parents Expect Pediatricians to Pay Attention to Behavioral Health? Clin Pediatr (Phila) 2015; 54:888-93. [PMID: 25644647 DOI: 10.1177/0009922815569199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE This study is a qualitative analysis examining caregivers' expectations for pediatricians with regard to behavioral health care. METHODS Fifty-five parents/caregivers of children seen in an urban primary care clinic participated in semistructured interviews. Participants were parents or guardians of children between the ages of 2 and 17 years, referred from the pediatric clinic to the mental health center. Interviews were analyzed using grounded theory methods. RESULTS Pertinent themes were the following: expected range of care, components of an effective primary care provider (PCP) relationship, action of the PCP, and parent reaction to PCP intervention. Forty-seven percent of caregivers saw the PCP role as strictly for physical health care; 53% expected the PCP to have a role in both physical and behavioral health. Responses were overwhelmingly positive from caregivers when the PCP asked about or conducted a behavioral health intervention. CONCLUSION Caregivers did not consistently expect but responded positively to PCPs engaging around behavioral health concerns.
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Affiliation(s)
| | - Sean Lynch
- University of Florida, Jacksonville, FL, USA
| | | | | | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry Solomon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Li TY, Lo JL. The predictors of uncertainty in mothers of children with autism spectrum disorder. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2014.979924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Miller MK, Wickliffe J, Jahnke S, Linebarger JS, Dowd D. Accessing General and Sexual Healthcare: Experiences of Urban Youth. VULNERABLE CHILDREN AND YOUTH STUDIES 2014; 9:279-290. [PMID: 25101138 PMCID: PMC4119761 DOI: 10.1080/17450128.2014.925170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Urban adolescents face many barriers to health care that contribute to health disparities in rates of sexually transmitted infections (STIs) and unintended pregnancy. Designing interventions to increase access to health care is a complex process that requires understanding the perspectives of adolescents. We conducted six focus groups to explore the attitudes and beliefs about general and sexual health care access as well as barriers to care among urban, economically disadvantaged adolescents. Participants first completed a written survey assessing health behaviors, health care utilization, and demographics. The discussion guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, and perceived behavioral control. Transcripts of group discussions were analyzed using directed content analysis with triangulation and consensus to resolve differences. Fifty youth participated (mean age 15.5 years; 64% female; 90% African American). Many (23%) reported missed health care in the previous year. About half (53%) reported previous sexual intercourse; of these, 35% reported no previous sexual health care. Youth valued adults as important referents for accessing care as well as multiple factors that increased comfort such as good communication skills, and an established relationship. However, many reported mistrust of physicians and identified barriers to accessing care including fear and lack of time. Most felt that accessing sexual health care was more difficult than general care. These findings could inform future interventions to improve access to care and care-seeking behaviors among disadvantaged youth.
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Affiliation(s)
- Melissa K. Miller
- Emergency and Urgent Care, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, 64108 USA
| | - Joi Wickliffe
- Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Sara Jahnke
- Center for Fire, Rescue & EMS Health Research, National Development & Research Institutes, Overland Park, USA
| | | | - Denise Dowd
- Emergency and Urgent Care, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, 64108 USA
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Kohlsdorf M, Costa-Junior ÁL. Comunicação em pediatria: revisão sistemática de literatura. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2013. [DOI: 10.1590/s0103-166x2013000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A qualidade da comunicação em Pediatria influencia diretamente o sucesso do tratamento, ao promover níveis satisfatórios de adesão, retenção de informações e acolhimento a demandas biopsicossociais. Constituiu objetivo deste trabalho realizar uma revisão sistemática da literatura referente à comunicação em pediatria publicada entre 2000 e 2010. Foram selecionados trabalhos incluídos nas bases de dados PubMed/MedLine, Bireme/BVS e ScienceDirect, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e SciELO. Os 61 trabalhos selecionados indicam prevalência de delineamentos descritivos e técnicas de análise qualitativas e quantitativas, em detrimento de estudos experimentais e uso de técnicas mistas para análise de dados. A literatura indica a importância da inclusão do paciente pediátrico no processo de comunicação e do acolhimento a demandas psicossociais, destacando que programas para melhoria da comunicação têm obtido bons resultados. Destaca-se a importância de estudos sistemáticos que possibilitem compreender os fatores envolvidos na comunicação em pediatria e a inserção de programas psicossociais eficientes.
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Mitchell LE, Lynch S, Lynch S. Are pediatricians doing more family "therapy" than they realize? Changing families through single encounters. Clin Pediatr (Phila) 2013; 52:978-80. [PMID: 22811324 PMCID: PMC4011067 DOI: 10.1177/0009922812453198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Sean Lynch
- Department of Psychiatry, Assistant Professor, University of Florida, Jacksonville
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Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Soc Sci Med 2013; 91:10-4. [PMID: 23849233 DOI: 10.1016/j.socscimed.2013.05.005] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/26/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
People's trust in the health system plays a role in explaining one's access to and utilization of medical care, adherence to medications, continuity of care, and even self-reported health status. Yet it is not easy to find trust measures and understand what they are measuring. A systematic review of scales and indices identified 45 measures of trust within the health system with an average of 12 questions each, which quantified levels of trust among various relationships across the health system. Existing evidence was narrow in scope, where half examined the relationship between doctors/nurses and patients, and the majority were designed, tested and validated in the United States. We developed a health systems trust content area framework, where we identified that honesty, communication, confidence and competence were captured frequently in these measures, with less focus on concepts such as fidelity, system trust, confidentiality and fairness. Half of the measures employed a qualitative method in the design of these measures and 33% were pilot tested. Reporting of test-retest reliability and inter-rater reliability were less common. This review identifies a need to develop measurements of trust beyond doctor-patient relationships and outside of U.S. contexts, and strengthen the rigor of existing trust measures. Greater development and use of trust measures in the health system could improve monitoring and evaluation efforts, which may in turn result in better health outcomes.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States.
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African-American parents' trust in their child's primary care provider. Acad Pediatr 2012; 12:399-404. [PMID: 22858071 PMCID: PMC3455113 DOI: 10.1016/j.acap.2012.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 06/03/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Patients' trust in their primary care providers has important implications in terms of health outcomes and, among minority patients, mitigating racial health disparities. This study aims to identify family, provider, and health care setting characteristics that predict African American parents' trust in their child's primary care provider and whether provider partnership-building communication style explains this association. METHODS Data were collected via retrospective telephone interviews completed 2 weeks after a child's health care visit to 1 of 7 pediatric primary care clinics in Washington, DC (3 community health centers, 3 private practices, and 1 hospital-based clinic). Four hundred twenty-five self-identified African American parents of children 0 to 5 years of age participated. Parents completed several standard survey instruments about trust and provider communication style as well as demographic questionnaires about their family and their child's provider. RESULTS A step-wise linear regression revealed significant independent effects of having a previous relationship with the provider and seeing a provider in a community health center (CHC) on higher trust. There was also evidence of mediation by provider communication style, suggesting that parents who take their child to a CHC report greater trust in their child's provider because they have higher perceptions of provider partnership building. CONCLUSIONS African American parents' trust in their child's provider may be enhanced by continuity of care and greater use of a partnership-building communication style by providers.
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Migration background and patient satisfaction in a pediatric nephrology outpatient clinic. Pediatr Nephrol 2012; 27:1309-16. [PMID: 22366897 DOI: 10.1007/s00467-012-2133-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND We examined the association of a migration background and patient satisfaction in a pediatric nephrology outpatient clinic in Germany. METHODS This was a cross-sectional study of 348 families presenting at the Pediatric Nephrology Outpatient Department of Charité University Children's Hospital in Berlin during 2008. Parents were asked to complete a questionnaire containing basic sociodemographic information, a subjective categorical rating of disease severity and communication with the medical team, and a validated patient satisfaction score (ZUF-8) derived from a customer satisfaction score used by industry and modified for healthcare providers. RESULTS Of the 348 families included in the study, 131 patients (38 %) had a migration background (20 different nationalities, 22 different native languages). Patient satisfaction (rated on a scale from 8 to 40) was significantly higher in families without (32.9 ± 4.6) than in those with a migration background (30.8 ± 4.7; p < 0.0001). A multivariate linear regression analysis revealed that trust in doctors, friendliness of the doctor, severity of the child's disease, number of medications prescribed, and a migration background were significantly and independently correlated with patient satisfaction. CONCLUSIONS Migrant families were less satisfied with the provision of the outpatient care provided by our department than non-migrants.
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Ozawa S, Walker DG. Comparison of trust in public vs private health care providers in rural Cambodia. Health Policy Plan 2011; 26 Suppl 1:i20-9. [PMID: 21729914 DOI: 10.1093/heapol/czr045] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
How trust in providers affects health care-seeking behaviour is not well understood. Focus groups and household surveys were conducted in Cambodia to examine how villagers describe their trust in public and private providers, and to assess whether a difference exists in provider trust levels. Our findings suggest the reasons for trusting public and private providers differ, and that villagers' trust in and relationship with providers is one of the important considerations affecting where they seek care. People believed that public providers were 'honest' and 'sincere', did not 'bad mouth people' and explained the 'status of [the] disease'. Villagers trusted public providers for their skills and abilities, and for an effective referral system. In contrast, respondents noted that seeing private providers was 'comfortable and easy', that they 'come to our home' and patients can 'owe [them] some money'. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact. Among those who sought care in the past 30 days, trust in the health care provider was listed as the fifth and second most important consideration for choosing public or private providers, respectively. This study illustrates the importance of trust as a unique concept that can affect people's choice of health care providers in a low-income country.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E8003, Baltimore, MD 21205, USA.
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Klein M, Vaughn LM, Baker RC, Taylor T. Welcome back? Frequent attenders to a pediatric primary care center. J Child Health Care 2011; 15:175-86. [PMID: 21828169 DOI: 10.1177/1367493511404721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).
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Affiliation(s)
- Melissa Klein
- Cincinnati Children's Hospital Medical Center, General & Community Pediatrics, Cincinnati, OH 45229, USA.
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Kenney MK, Kogan MD. Special needs children with speech and hearing difficulties: prevalence and unmet needs. Acad Pediatr 2011; 11:152-60. [PMID: 21396617 DOI: 10.1016/j.acap.2011.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/08/2011] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to establish prevalences and sociodemographic characteristics associated with parent-reported speech and hearing difficulties among children with special health care needs (CSHCN); determine unmet needs for therapy, hearing aids, and communication devices; and examine the association between unmet needs and resources such as health insurance, early intervention/special education, and a medical home. METHODS Data were analyzed for 300,910 children without special health care needs and 40,723 CSHCN from the 2005-2006 National Survey of Children with Special Health Care Needs. Prevalence, sociodemographic characteristics, and unmet needs for 7132 CSHCN with speech difficulties and 1982 CSHCN with hearing difficulties were assessed. Logistic regression was used to determine the associations between unmet needs for therapy or hearing/communication devices and resources for addressing needs for therapy, hearing, and communication aids. RESULTS The parent-reported prevalence of speech difficulty among CSHCN in the general population was 2.9% and approximately 20% among all CSHCN, in contrast to the lower prevalence of hearing difficulty (0.7% and 5%, respectively). Relative unmet need was greatest for communication devices and least for hearing aids. The strongest association with reducing unmet needs was having a medical home, and the most significant aspect of medical home was having effective care coordination. CONCLUSIONS Having a medical home is significantly associated with fewer unmet needs for therapy and hearing/communication devices among CSHCN with speech and hearing difficulties. Care coordination may constitute an important factor that allows the primary care provider to link with services that CSHCN with communication problems require.
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Affiliation(s)
- Mary Kay Kenney
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland 20857, USA.
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Abstract
BACKGROUND Parents consult other child health information sources in addition to the pediatrician. There are little data describing which of these sources parents are likely to follow. METHODS The authors surveyed 543 parents of patients in 6 pediatric practices in southeast Michigan shortly after an office visit to determine the degree to which parents report following advice from 7 common child health sources on a scale from 1 (don't follow at all) to 7 (follow completely). RESULTS Pediatrician advice was more completely followed than other sources with mothers a distant second. Although 96% of parents used the Internet to find child health information, few followed most of the advice found there. White parents were 3 times more likely than African Americans to follow advice from television and newspapers. CONCLUSION Parents rely on child health advice from the pediatrician and their mother. Other sources are consulted but not widely followed.
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Affiliation(s)
- Kathryn L Moseley
- Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109-0456, USA.
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Abstract
OBJECTIVE The goal of this study was to explore the role of communication in building trust between intensivists and parents in the pediatric intensive care unit. METHODS Semistructured qualitative interviews were administered to English-speaking parents of children who were admitted to the pediatric intensive care unit for at least 48 hrs. Parents were asked about the factors impacting trust and communication in the pediatric intensive care unit. Qualitative data were managed with NVIVO software (QSR International, Southport, UK) and analyzed for themes. RESULTS Participants were 122 parents (41% black, 40% white). Most parents articulated that communication is integral to building trust. Specifically, parents described that they wanted healthcare workers to communicate in ways that were Honest, Inclusive, Compassionate, Clear and Comprehensive, and Coordinated, which can be summarized using the acronym, HICCC. In addition, nonwhite parents were more likely than white parents to report instances when they felt doctors did not listen to them (p = 0.0083). Parents from minority groups reported instances of self-experienced or observed discrimination in healthcare with greater frequency than white parents. When asked to identify their pediatric intensive care unit doctor, 46% of parents were either unable to do so or named doctors from other hospital departments. CONCLUSIONS Communication is vital to building trust in the pediatric intensive care unit. Developed from parents' own observations and perspectives, HICCC is an accessible framework that can help doctors to remember what parents value in communication in the acute care setting. In addition, pediatric intensivists would benefit from targeted cultural competency training to reduce physician bias.
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Abstract
In healthcare, there is an undeniable need for cultural competence in order to address the health needs of our growing, pluralistic families, eliminate existing health disparities, mend a fragmented system of care where some receive better services than others, and meet the required standards of accreditation bodies within health training programs. This review addresses the foundation, history, and complexity of cultural competency in healthcare and medicine. There is a description of current training in and evaluation of cultural competency, models of cultural competence, and future directions in research and training in the area of cultural competency.
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Affiliation(s)
- Lisa M Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Rajakumar K, Thomas SB, Musa D, Almario D, Garza MA. Racial differences in parents' distrust of medicine and research. ACTA ACUST UNITED AC 2009; 163:108-14. [PMID: 19188641 DOI: 10.1001/archpediatrics.2008.521] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess and compare the attitudes and trust that African American and white parents have toward their children participating in research. DESIGN Self-administered, cross-sectional survey of a convenience sample of parents. SETTING Primary Care Center at Children's Hospital of Pittsburgh from August 2004 through April 2005. PARTICIPANTS One hundred ninety parents (140 African American and 50 white parents). OUTCOME MEASURE Parental distrust of medical research as measured by a summative score of distrusting responses to 8 questions assessing trust in research. RESULTS African American parents had significantly greater distrust than white parents (67% vs 50%, P = .04). Education was also associated with having significantly greater distrust (74% of those with <high school education vs 44% of college graduates, P = .03). However, African American race remained a predictor of distrust even when education was controlled for (odds ratio, 2.25; 95% confidence interval, 1.01-5.01). CONCLUSIONS The degree of parental distrust toward medical research was significantly greater among African American parents. Parental distrust may be a barrier to enrollment of African American children in clinical research. Strategies for overcoming the higher level of distrust in African American parents are warranted for ensuring adequate representation of African American children in clinical research.
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Affiliation(s)
- Kumaravel Rajakumar
- General Academic Pediatrics, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213-2583, USA.
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Postpartum mothers' attitudes, knowledge, and trust regarding vaccination. Matern Child Health J 2007; 12:766-73. [PMID: 17987370 DOI: 10.1007/s10995-007-0302-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine attitudes and knowledge about vaccinations in postpartum mothers. METHODS This cross-sectional study collected data via written survey to postpartum mothers in a large teaching hospital in Connecticut. We used multivariable analysis to identify mothers who were less trusting with regard to vaccines. RESULTS Of 228 mothers who participated in the study, 29% of mothers worried about vaccinating their infants: 23% were worried the vaccines would not work, 11% were worried the doctor would give the wrong vaccine, and 8% worried that "they" are experimenting when they give vaccines. Mothers reported that the most important reasons to vaccinate were to prevent disease in the baby (74%) and in society (11%). Knowledge about vaccination was poor; e.g., 33% correctly matched chicken pox with varicella vaccine. Mothers who were planning to breastfeed (P=.01), were primiparous (P=.01), or had an income<$40,000 but did not receive support from the women, infants, and children (WIC) program were less trusting with regard to vaccines (P=.03). Although 70% wanted information about vaccines during pregnancy, only 18% reported receiving such information during prenatal care. CONCLUSION Although the majority of infants receive vaccines, their mothers have concerns and would like to receive immunization information earlier. Mothers who are primiparous, have low family incomes but do not qualify for the WIC program, or are breastfeeding may need special attention to develop a trusting relationship around vaccination. Mothers would benefit from additional knowledge regarding the risks and benefits of vaccines particularly during prenatal care.
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Abstract
PURPOSE This article reviews research in the U.S.A. bearing on trust in physicians and medical institutions. DESIGN/METHODOLOGY/APPROACH This article provides a conceptual analysis, and general review of the literature. FINDINGS Empirical research of medical trust is burgeoning in the U.S.A., and a fairly clear conceptual model of interpersonal physician trust has emerged. However, most studies focus on individual patients and their physicians, due to the highly individualistic attitudes that prevail in the U.S.A. Lacking are studies of more social dimensions of trust in broader medical institutions. A conceptual model of trust is presented to help draw these relevant distinctions, and to review the US literature. Also presented are the full set of trust scales, developed at Wake Forest University, which follow this conceptual model. These conceptual categories may differ, however, in other languages and cultures. ORIGINALITY/VALUE The considerable body of research in the USA on patients' trust in individual physicians should help inform and focus international efforts to study social trust in medical institutions.
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Affiliation(s)
- Mark A Hall
- Wake Forest University, Winston-Salem, North Carolina, USA.
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