Preserving the child as a respondent: Initiating patient-centered interviews in a US outpatient tertiary care pediatric pain clinic

Abstract

This article identifies some of the challenges of implementing patient-centeredness in multiparty clinical visits. Specifically, it describes four interview practices with which clinicians address these challenges in a US outpatient tertiary care pediatric pain clinic. Using the qualitative method of conversation analysis, we analyze clinicians' child-directed (ages 10-18) interviewing during the initial stage of 51 intake visits. In particular, we analyze the challenges involved in open-ended questioning, a form of interviewing associated with patient-centeredness. Open-ended questioning presents participants with competing demands: although it gives children an opportunity to talk about their illness in their own terms, it also asks them to be responsible for a larger part of the communication work. Moreover, the presence of a parent as an alternative informant can lead to the loss of the child as an informant if clinicians fail to give the child, particularly younger ones, enough guidance in answering. We argue that a flexible range of interviewing practices may be a step towards offsetting children's and parents' past negative experiences with clinicians, improving patient outcomes and implementing child/patient-centeredness.

Community Palliative Care Nurses’ Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care

“…21 Having flexible and innovative communication skills with both child and parents can improve rapport and promote patient/familycenteredness care. 22 As the nurses revealed, it takes time to build rapport and trust with a child and their family but it has shown to improve outcome and satisfaction. 21 A child dying is unnatural and nurses in our study found dealing with emotions arising within themselves and from parents challenging.…”

Attending to child agency in paediatric palliative care consultations: Adults’ use of tag questions directed to the child

“…At the same time, because a response was not an interactional necessity for the conversation to proceed, the tag questions did not place a burden of responding on the child in a way that a more open, information-soliciting question might do. The use of tag questions in this environment builds on prior research by Clemente (2009) and Clemente et al (2012), who showed that practices such as closed-ended questioning place fewer demands on the child, which may help to reduce the risk of no response, or a parent responding instead of the child.…”

“…Children's talk, however, typically only accounts for around 5% of the conversation during paediatric consultations, with most talk being a dyadic exchange between a health-care professional and the child's parent or guardian (Cahill, 2010;Cahill & Papageorgiou, 2007). Clinicians and parents or guardians face the challenge of providing opportunities for children to participate but without imposing burdens on the child that may make them unwilling or unable to actively participate in the consultation (Clemente et al, 2008(Clemente et al, , 2012.…”

“…Recent conversation analytic research has identified ways clinicians can encourage child participation in health-care consultations (Cahill, 2010;Clemente et al, 2008Clemente et al, , 2012Stivers, 2001). Children were found to be more likely to contribute to the history-taking phase of a consultation when they were explicitly selected as the recipient of a question, through practices such as using the child's name or gazing at them (Cahill, 2010;Stivers, 2001).…”

Decision‐Making in Paediatric Rehabilitation: Exploring Professionals' and Children's Views on Decision‐Making Involvement

“…Decision‐making highlights how the child participates and is listened to together with professionals and parents. However, situating the child at the centre of the conversation at the start of the consultation can be challenging (Clemente and others, ). Studies have found that professionals rarely discuss children's involvement as a topic of importance (Garth and others, ; Schalkers and others, ).…”