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

https://doi.org/10.1016/j.pec.2014.01.010Get rights and content

Abstract

Objective

To investigate parents’ experiences and views of clinician communication during primary care consultations for respiratory tract infections (RTIs) in children under 12.

Methods

Semi-structured interviews with 30 parents who had recently consulted for RTI in their child. Purposive sampling was used to interview parents from a range of socio-economic areas.

Results

Parents critically assess the credibility of primary care clinician diagnosis and treatment recommendations based on their perception of the medical evaluation and how well their concerns and expectations have been addressed. A “viral” diagnosis could be perceived as trivializing, particularly when contradicting the parent's perception of severity. Parents expected advice on symptomatic treatment and felt frustrated by ‘no treatment’ recommendations. Parents commonly reported safety netting advice which was too vague to be useful.

Conclusion

Parents’ perception of the credibility of the diagnosis and treatment recommendations is influenced both by their expectations and the effectiveness of clinician communication. Opportunities are being missed to inform parents about symptomatic care and when to consult for children with RTIs.

Practice implications

Clinicians should tailor diagnostic explanations to parental expectations and concerns and address the symptoms of significance to parents. Clinicians should provide advice about symptom relief and more precise safety netting advice.

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

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