The current state of patient-to-provider communication of childhood adversity in primary care

Primary care nurse practitioners' perceptions and experiences communicating with adults about adverse childhood experiences

BACKGROUND

Clinical communication focused on childhood adversity has not been well described in the extant literature. There is a wealth of knowledge about patient-centered communication, including patient-centered communication techniques involving the discussion of health risks in primary care. However, there remain gaps in our understanding of the role that communication plays in exploring adverse childhood experience (ACE) exposure among adults in the clinical context.

PURPOSE

To better understand factors that influence how nurse practitioners (NPs) communicate with adults about ACEs in the context of primary care while simultaneously exploring NPs' perceptions and experiences of their ability to communicate with adults about ACE exposure.

METHODOLOGY

Guided by the Patient-to-Provider Communication of Adverse Childhood Experiences in Primary Care (PPC-ACE) Model, an exploratory, qualitative, descriptive study was conducted among 15 US-based primary care NPs. Nurse practitioner's participated in semistructured interviews, which were recorded and transcribed. Transcripts were analyzed using inductive thematic analysis. Atlas.ti provided supplemental data visualization. Demographic data, practice characteristics, and baseline ACEs knowledge were collected by means of Qualtrics.

RESULTS

Key themes described communication approaches and perceived barriers and facilitators to ACE-related conversations. Scope of practice, provider biases, diversity in practice models, and secondary trauma were factors NPs' perceived as positively or negatively influencing ACE-related communication in primary care.

CONCLUSIONS

Outcomes from this study provided deeper insights into the various influencers of NP-perceived, ACE-related, patient-centered communication among adults in primary care.

IMPLICATIONS

Findings will inform future research focused on ACE-related communication in primary care in the domains of NP education, practice, and health policy.

A Conceptual Model to Guide Patient-to-Provider Communication of Adverse Childhood Experiences in Primary Care

Communicating with adults about childhood adversity is not an innate clinical skill nor is it a routine assessment element. Nurse practitioners may be aware of the significance adverse childhood experience (ACE) exposure has on adult health and well-being; however, they may not be prepared to identify, interpret, and subsequently act on that information. This article presents the development of a conceptual model to guide patient-to-provider communication of adverse childhood experiences in primary care (the PPC-ACE model). This includes a description of the model and its associated foundational elements, underlying assumptions, implications for nursing practice, and opportunities to use this model to guide future ACEs-related research.