A proposal for a behavioral pre-consultation: Analysis of the use of a protocol during consultations

Abstract

This study aimed to analyze how physicians, caregivers, and children use protocols regarding estimated issues to medical visits, procedure named pre-consultation lists, along treatment for childhood cancer. Three pediatricians and 24 dyads child-caregiver took part; each pair was interviewed before medical visits in order to report doubts, needs and issues estimated to the consultation. This list was attached to child's medical record as a memo of themes to discuss in the next medical visit. Results show that two physicians included effectively this file in their consultations and discussed a great amount of issues listed by caregivers and patients. Children did not refer to the listed issues, but parents, in smaller amounts, discussed the themes in the protocol. This procedure contributed to insert the child in consultations and it may facilitate the focus on specific themes, however the physician's main role in managing communication during pediatric medical visits is highlighted.

Pediatric cancer communication in low‐ and middle‐income countries: A scoping review

“…One‐quarter of the studies directly involved children, and 2 studies focused exclusively on patient participants 21,60 . Of the 9 studies including health care workers, 22‐24,31,32,35,38,42,54 2 focused on nursing perspectives 22,42 . Studies were conducted at all phases of cancer care, from diagnosis through bereavement.…”

“…Patient and caregiver barriers included a lack of education, social support, and socioeconomic resources 40,60 . Barriers related to the communication interaction included cancer misconceptions 51,58 and perceived hierarchy between patients and providers 24,33,34,57,59 . Cancer misconceptions were exacerbated when oncologist communication was limited (Egyptian study) 52 or when providers used inconsistent, incorrect, or undefined medical terms to describe the disease and treatment, as reported from Indonesia, Brazil, and Mexico 26,38,54 .…”

“…Enablers of communication included preconsultation lists of discussion topics, 24,27 an initial family meeting with a multidisciplinary team, 28,34,36,48 parental education programs, 55 and use of puppets 21 or drawings 29 for communication with the child. Other factors that enabled communication included written, verbal, and nonverbal communication tools 37,48 ; an established therapeutic relationship with the medical team 26,30,32,49,60 ; plenty of time for communication 31,34 ; and extended support for caregivers 28,31,58 …”

“…A majority of the studies (60%) addressed challenges around direct or indirect diagnostic disclosure to children, including differences in provider‐caregiver and provider‐patient communication 21,24,25,35,53 and disclosure practice variation based on child age 31,38 . Most studies focused on caregiver perceptions regarding the involvement of their child in communication 35,36,47,53 .…”

“…In 22 studies (55%), other members of the medical team, including nurses, 22,28,30,33,41,42,45,54,57‐59 social workers, 28,29,57 psychologists, 28,29,57 and general health care workers, 34,35,40,59 were referenced as primary communicators. Studies including both caregiver and provider participants sought to holistically explore challenges, communication dynamics, and provider‐family relationships 23,24,31,32,35,38,54 . For example, in a study from Iran, caregivers described the negative attitude of a medical team toward information sharing, whereas providers depicted parents as gatekeepers hesitant to share information with their adolescent children 32 .…”