Patient Perception, Preference and Participation“They just say everything's a virus”—Parent's judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: A qualitative study
Introduction
Acute respiratory tract infection (RTI) in children is the most common reason why parents consult primary care in the UK [1]. Communication within these consultations is often fraught with misunderstanding that can contribute to unnecessary repeat consultations and the over-prescription of antibiotics [2], [3]. Inappropriate prescribing of antibiotics in the pediatric population is a serious problem [4]. Primary care practitioners are responsible for 80% of all antibiotics prescriptions, about half for RTI [5]. Despite evidence of limited or marginal effectiveness [6] they continue to be widely prescribed, contributing to increasing bacterial resistance to antibiotics [7], a problem now at the top of the public health agenda [8]. However, a recent systematic review of consultation interactions suggests that such misunderstandings are under-studied and parents’ perceptions are seldom considered [9].
Communication in pediatric consultations can be complex due to the triadic interaction [10]. Parents commonly speak for their child and the needs and anxieties of the parent can take priority [11], [12]. Parents can find it difficult to understand acute illness in their child and feel disempowered by inadequate information sharing by doctors [13]. In particular, parents report receiving insufficient information and being left with uncertainty after consultations for RTI [14].
Effective communication in medical consultations is associated with greater patient satisfaction [15] and improved health outcomes [16]. Communication skills training has been shown to reduce antibiotic prescribing significantly for RTI in adults [17], [18] and the use of an interactive booklet to aid communication was shown to reduce antibiotic prescribing for children with RTIs without reducing parent satisfaction [19]. However, a recent review found that patients’ views on doctor–patient communication in primary care are relatively under researched [20]. Studies have found that pediatricians use only a limited range of communication techniques in consultations [21] and that communication varies considerably between clinicians [21] and between consultations for different types of medical problems [22], [23]. A recent study focused on parents’ acceptance of antibiotic prescribing decisions for children with RTI and found that trust, open communication and continuity of care played a key role [24]. The study reported here aimed to improve our understanding of parents’ experiences and views of clinician communication at all stages of the primary care consultation for a child with a RTI.
Section snippets
Methods
Semi-structured interviews were conducted with parents who had recently consulted primary care because their child had an RTI. Six GP practices were purposively selected to obtain practices with populations from a range of socio-economic situations (SES) and from both rural and urban areas. Practices were assigned to 1 of 5 SES categories using the practice level indices of multiple deprivation (IMD) scores [25] so that practices with an IMD score which put them in the most deprived quintile
Sample description
Twenty-one mothers and two fathers were recruited through practices and seven mothers through parent groups and included a range of parents in terms of SES, education levels, age of parent, and number and age of children (Table 1). Most parents were of white British ethnicity. Consulting rates ranged from 1 to 24 per year (for the youngest child).
Four major themes were generated from the data. The first related to the role of communication in parents’ perception of whether or not a credible
Discussion
Our study provides key insights into parents’ views of communication in consultations for children with RTI. Firstly, the parents described judging the credibility of diagnosis and treatment recommendations based on their perceptions of the clinician's communication (whether or not they appeared to be listening, caring, taking their time) and the physical exam (whether a “proper check” is conducted). Secondly, the parents described how their perceptions of the seriousness of their child's
Contributors
JH, JI, AH and CC were responsible for developing the research questions and study design; CC, JH and JI for study management and CC, JH, JI and AH for writing the manuscript; CC accepted the final version.
Conflict of interest
The authors report no conflicts of interest and have no financial interests in the content of this manuscript.
Acknowledgements
We would like to thank all the parents who took part in the study and other members of the TARGET programme team who commented on the paper.
The TARGET team members: Alastair D. Hay, Andrew Lovering, Brendan Delaney, Christie Cabral, Hannah Christensen, Hannah Thornton, Jenny Ingram, Jeremy Horwood, John Leeming, Margaret Fletcher, Matthew Thompson, Niamh Redmond, Patricia Lucas, Paul Little, Peter Blair, Peter Brindle, Peter Muir, Sandra Hollinghurst, Sue Mulvenna, Talley Andrews, and Tim
References (40)
- et al.
‘Let Mum have her say’: turntaking in doctor–parent–child communication
Patient Educ Couns
(2000) - et al.
How patients want their doctor to communicate. A literature review on primary care patients’ perspective
Patient Educ Couns
(2013) - et al.
Communication techniques used by pediatricians during well-child program visits: a pilot study
Patient Educ Couns
(2010) - et al.
Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice
Soc Sci Med
(2001) Pediatrician–parent–child communication: problem-related or not
Patient Educ Couns
(2004)- et al.
Endpoints in medical communication research, proposing a framework of functions and outcomes
Patient Educ Couns
(2009) - et al.
Patient-centred consultations and outcomes in primary care: a review of the literature
Patient Educ Couns
(2002) - et al.
What parents and carers think medical students should be learning about communication with children and families
Patient Educ Couns
(2009) - et al.
Developing an ‘interactive’ booklet on respiratory tract infections in children for use in primary care consultations
Patient Educ Couns
(2008) - et al.
Morbidity statistics from general practice. Fourth national study 1991–1992
(2006)
Inside the routine general practice consultation: an observational study of consultations for sore throats
Fam Pract
Why do physicians think parents expect antibiotics? What parents report vs. what physicians believe
J Fam Pract
Antimicrobial use in defined populations of infants and young children
Arch Pediatr Adolesc Med
Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries
Brit Med J
Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis
Brit Med J
Annual report of the Chief Medical Officer 2011
Decision making in consultations for RTI in children: a systematic review and meta-ethnographic synthesis of qualitative data
Triadic communication in the primary care paediatric consultation: a review of the literature
Br J Gen Pract
Interactive frames and knowledge schemas in interaction: examples from a medical examination/interview
Soc Psychol Quart
Cited by (72)
The Path Towards Effective Respiratory Syncytial Virus Immunization Policies: Recommended Actions
2023, Archivos de BronconeumologiaThe importance of viral testing in infants and young children with bronchiolitis
2022, Jornal de PediatriaAttitudes towards vaccination and knowledge about antibiotics: Analysis of Wellcome Monitor survey data
2022, VaccineCitation Excerpt :If the commonalities between vaccine-related attitudes and understanding of antibiotics’ use suggested in this study signify broader similarities between types of vaccine hesitancy and public comprehension of the role of antibiotics, a deeper understanding of how these phenomena relate to one another may have use in improving public health communication on these issues. Previous research has highlighted the importance of social and cultural context alongside personal experience for understanding specific attitudes towards vaccination [25,32], and similar contextual influences have been discussed in the context of antibiotic use [35–37]. The future research indicated here should be cognisant of these influences, and consider medical and veterinary care contexts such as parental decision-making and veterinarian-client communication as well as broader dynamics within the general population regarding antibiotic use as well as vaccine decisions.
Reducing primary care attendance intentions for pediatric respiratory tract infections
2019, Annals of Family MedicineAntibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT
2023, Health Technology Assessment
- 1
The TARGET team members are listed in Acknowledgement section.