Patient-Centered Communication and Health Assessment With Youth

• Type of Material: Article
• Authors: Kristy Martyn, Emory University; Michelle L. Munro, University of Michigan; Cynthia S. Darling-Fisher, University of Michigan; David L. Ronis, University of Michigan; Antonia M. Villarruel, University of Michigan; Michelle Pardee, University of Michigan; Hannah Faleer, Northern Illinois University; Nicole M. Fava, Wayne State University
• Language: English
• Date: 2013-11-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Lippincott Williams & Wilkins.; Copyright © 2013 Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1097/NNR.0000000000000005
• Title of Journal or Parent Work: Nursing Research
• ISSN: 0029-6562
• Volume: 62
• Issue: 6
• Start Page: 383
• End Page: 393
• Grant/Funding Information: We gratefully acknowledge the following grant support by the National Institutes of Health and National Institute of Mental Health, R34-MH-082644 (PI: Kristy K. Martyn).; Support to Michelle Munro was provided by the National Institutes of Health, National Institutes for Nursing Research grant number F31NR012852.
• Keywords: CARE; Nursing; event history calendar; OUTCOMES; youth; adolescent; GUIDELINES; health communication; Life Sciences & Biomedicine; patient-centered communication; Science & Technology
• Research Categories: Health Sciences, Nursing

Abstract

BACKGROUND:: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. OBJECTIVES:: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. METHODS:: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). RESULTS:: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. DISCUSSION:: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.