Parents Reliably Identify Pain Dismissal by Pediatric Providers

Abstract

Objectives: Approximately 40% of children and adolescents with chronic pain report at least 1 dismissal experience, citing medical providers and parents as the primary and most distressing dismissers. Previous research indicates sex differences in pain dismissal experience and observer pain perception. This study examined parental reactions to dismissive provider-child scenarios and the influence of provider and patient sex on perceptions. Methods: Community parents (N=326) completed an online survey. Parents were randomized to listen to 1 of 8 vignettes of a provider-child chronic pain scenario. Vignettes varied by type of scenario (appropriate vs. dismissive)×provider sex×patient sex. Results: Overall, parents rated the dismissive scenario more negatively. There was a significant interaction between provider sex and scenario regarding likelihood to bring their own child to this provider and a significant 3-way interaction regarding provider belief of the pain complaint. When asked how they would feel if this was their own child, parents who heard the dismissive scenario reported more negative reactions. When asked what they would say to the provider, parents in the dismissive condition were more likely to defend their child and request a second opinion. Discussion: Parents consistently identified the dismissive language in a child and provider scenario. Female providers and sex-matched dyads seem to be more polarizing in terms of likelihood to bring their child to the provider and belief of pain, respectively. Providers within these groups may need to be especially cautious with their language when responding to pediatric chronic pain complaints.

Community-recruited parent perspectives of concern dismissal by pediatric providers.

“…A core tenet of FCC, high-quality communication in which one feels that their concerns are understood is an important correlate of parent satisfaction with health care (Beckett et al, 2009). Prior research on provider dismissal of patient concerns has focused on specific concern types, such as adolescent and emerging adult experiences of pain dismissal (Defenderfer et al, 2018;Igler et al, 2017Igler et al, , 2020Lang et al, 2018) and parents' developmental (Johnson et al, 2020) and mental health (Pidano, 2020;Pidano et al, 2017) concerns. The present study observed that a minority of parents reported at least one lifetime instance of pediatric concern dismissal, which was often associated with distress and dissatisfaction with the health care system.…”

“…Beyond surveys, future concern dismissal research should incorporate perspectives of providers and pediatric patients. This may include using recordings of pediatric medical encounters (Callery & Milnes, 2012;Giambra et al, 2018;Wissow et al, 1994Wissow et al, , 2005 or written vignettes (Igler et al, 2020;Lang et al, 2018), to allow for more objective study of concern dismissal. Prior vignette studies of pain dismissal experiences may also serve as models for more detailed explorations (e.g., Igler et al, 2020).…”

“…Considering extant evidence, provider dismissal of parent or patient concerns is consequential for both patient satisfaction and overall quality of care. Pain dismissal studies indicate that dismissive behavior by providers may precipitate unsatisfactory health care experiences (Igler et al, 2020; Lang et al, 2018). Lack of attendance to parent concerns by providers may also unnecessarily prevent or delay treatment.…”

Psychogastroenterology: A Cure, Band-Aid, or Prevention?

“…Children who report symptoms are assumed to make the symptoms up or have a mental disorder. These patients are often thought to be demanding and dismissed by physicians [ 15 , 16 ]. Families carry theses same beliefs.…”

“If It Ever Really Hurts, I Try Not to Let Them Know:” The Use of Concealment as a Coping Strategy Among Adolescents With Chronic Pain

“…Youth with chronic pain, and their families, experience this diagnostic uncertainty in the context of repeated negative medical findings ( Neville et al, 2019 ), alongside providers who may not feel confident in their management of pediatric chronic pain ( Neville et al, 2020 ). Many parents have also indicated feeling that their child’s pain symptoms are often dismissed by pediatric providers ( Igler et al, 2020 ). The invisibility of chronic pain symptoms has led to adolescents with chronic pain experiencing pain-related stigma, specifically in the form of others indicating that they do not believe their pain is “real,” and/or believing that the person is making up their symptoms ( Wakefield et al, 2018 ).…”