Pediatrician Interview Style and Mothers' Disclosure of Psychosocial Issues

Abstract

Objective. Primary care pediatricians play an important role in the detection, diagnosis, treatment, and referral of children with mental health problems. Some parents, however, are reluctant to discuss behavioral and emotional symptoms with their child's pediatrician. Studies of patient-physician communication suggest that specific aspects of pediatrician interview style (asking questions about psychosocial issues, making supportive statements, and listening attentively) increase disclosure of sensitive information. We hypothesized that disclosures of parent and child psychosocial problems would be more likely to occur during visits when pediatricians used these techniques. Design. Cross-sectional analysis of a systematic sample of pediatric primary care visits. Population. Two hundred thirty-four children ages 6 months to 14 years and their mothers or female guardians attending an inner-city hospital-based pediatric primary care clinic; 52 physicians in their second or third year of pediatric residency training. Methods. Visits audiotaped and dialogue coded using the Roter Interactional Analysis System. Independent variables included counts of pediatrician utterances in the following categories: (a) questions about psychosocial issues, (b) statements of support and reassurance, and (c) statements indicating sympathetic and attentive listening. Dependent variables were the disclosure of information about: (a) parental medical or emotional impairment, (b) family disruption, (c) use of physical punishment, and (d) aggressive or overactive child behavior. Results. Use of psychosocially oriented interviewing techniques was associated with a greater likelihood of disclosure for all four of the topic areas studied. Odds ratios for disclosure, adjusted for parental concerns and child age, ranged from 1.09 to 1.22 depending on the interview technique and outcome involved. Positive associations were observed both for topics raised primarily in response to pediatrician questions (family and parent problems) and for topics raised primarily by mothers (behavior and punishment). Conclusions. Three simple communication skills were associated with disclosure of specific concerns relevant to child mental health. Training pediatricians to use these skills would help to better detect and diagnose children's mental health problems.

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

“…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).…”

Identifying and Managing Suicidality in Children and Adolescents with Chronic Pain: Evidence-Based Treatment Strategies

“…Again, direct questioning is most conducive to disclosure in discussing psychosocial issues with parents. 86 Parents often may not know about an adolescent's suicidal thoughts, or they may overreport concerns. 87 In a study of psychiatrically hospitalized adolescents and their parents, adolescents reported significantly more suicidal ideation, plans, and attempts than their parents.…”

“Doctor, are you listening?” Communication about children’s mental health and psychosocial concerns.

“…Results of an early study indicated that “three simple communication skills” (Wissow, Roter, & Wilson, 1994, p. 289) were related to disclosure of mental health or psychosocial issues; the authors identified these as “asking questions about psychosocial issues, making supportive statements, and listening attentively” (Wissow et al, 1994, p. 289). Wissow and colleagues (2003) have also noted the importance of “patient-centeredness,” which is congruent with these three skills and encompasses interpersonal sensitivity, partnership, and medical information giving, while others have reported a strong association between communication and parents’ perceptions of satisfaction and quality of care (Hart, Kelleher, Drotar, & Scholle, 2007).…”