Silence is golden

Exploratory study of language paediatricians use to promote adherence to long-term controller medication in children with asthma

INTRODUCTION AND OBJECTIVES

Although patient centred communication is associated with patients' daily medication adherence, the exact communication phenomena promoting high treatment adherence remain elusive.

PATIENTS AND METHODS

We used conversation analysis of videotaped follow-up consultations of seven outpatients (4-13 years of age) with chronic asthma and their caregivers, consulting two paediatric respiratory physicians in a practice in which high treatment adherence has been documented, to explore the language paediatricians use to promote their patients' adherence to daily controller medication.

RESULTS

Starting the consultation with the patient's (and caregivers') agenda commonly resulted in presentation of issues new to the physician. Information was mostly provided in response to patient/caregiver questions, prompting the delivery of specific information tailored to the patient's and caregivers' needs. Although patients and caregivers showed resistance in response to unsolicited information and advice, they always accepted the doctor's explicit request for agreement with proposed treatment. The doctor's description of favourable treatment results in most patients prompted caregivers' willingness to accept treatment proposals.

CONCLUSIONS

Paediatricians with a documented success in achieving adherence to controller medication in their patients with asthma tend to start consultations with the patient's agenda, provide information in response to questions, offer reassurance on overall treatment effectiveness, and seek explicit agreement with a treatment proposal.