Evaluating provider communication in pediatric chronic kidney disease care using a global coding system

Systematic review of observational coding systems to assess patient-healthcare professional interactions

OBJECTIVES

Systematic coding is used to study interactions between patients and healthcare professionals from an independent observer perspective. Many coding systems are available, but an up-to-date overview is lacking. We aimed to: (1) provide a comprehensive overview of systems for systematic coding of patient-healthcare professional interactions; and describe their 2) general characteristics and development, and 3) validation and adaptation.

METHODS

We systematically searched peer-reviewed empirical articles in five databases (Cochrane, Embase, PubMed/Medline, CINAHL, PsychINFO) using variations of the following keywords: (i) patient and/or other stakeholder, (ii) healthcare professional (iii), interactions in healthcare, (iv) coding tool, and (v) development and/or validation. All titles/abstracts and full-texts were screened independently and in duplicate. Additionally, coding systems were identified through an earlier review, an open-access research database, and a forward-reference search of all included coding systems up to that point. For all eligible systems, we extracted characteristics and psychometric properties.

RESULTS

From a total of 6950 identified articles from literature databases, 188 full-text articles were screened. Thirty-five articles were included from additional sources. In total, we included 124 articles describing 98 coding systems. Systems were highly variable in terms of topic (e.g., patient-centered communication, shared decision making, behavior change counseling), clinical context (e.g., oncology, pediatrics, generic), rigor of development and reporting, coding complexity, and extent of psychometric testing. Inter-rater reliability was reported for most coding systems; only few were tested for other types of reliability or for validity.

CONCLUSIONS

A plethora of coding systems are available, but more systematic reporting and psychometric testing are urgently needed to enhance evidence of validity. Testing may initially focus on the most relevant and broadly applicable coding systems.

PRACTICE IMPLICATIONS

These results can aid researchers in selecting the most suitable coding system for their purposes. Researchers may consider using or adapting existing systems, before developing new coding systems.

Pediatric Transplant Surgeons' Perspectives on Palliative Care for Children With Chronic Kidney Disease: A National Cross-Sectional Survey

BACKGROUND

Some adult transplant surgeons consider transplant to be contraindicated in patients receiving palliative care (PC). Little is known about pediatric transplant surgeons' attitudes toward PC. We sought to ascertain pediatric kidney transplant surgeons' perspectives regarding the routine integration of PC for children with chronic kidney disease.

METHOD

We administered a cross-sectional web-based survey to members of the American Society of Transplant Surgeons listserv in summer 2021. We adapted the survey from the previously validated Provider Survey about Palliative Care for Children with Heart Disease and pretested it with representative kidney transplant surgeons, nephrologists, and PC physicians; queries related to PC included institutional and personal experience, knowledge, and education. Data were summarized descriptively.

RESULTS

There were 21 participants. Over half of the respondents were white (57%) males (62%), practicing in urban, academic centers (94%). Although 67% of the participants practiced in an institution with a subspecialty PC team, 24% were unsure if such a team existed in their institution. A minority (19%) perceived PC consultation and kidney transplant to be mutually exclusive. Most surgeons (86%) believed that PC should not be restricted to when a child is dying, and 59% reported that PC consultation should happen at diagnosis for life-threatening conditions. However, surgeons indicated that PC consultation is rarely utilized for pediatric kidney transplant recipients. Transplant surgeons expressed a desire for additional PC-focused training and willingness to engage in additional education.

CONCLUSIONS

Although a minority of pediatric transplant surgeons perceived PC to be contraindicated for kidney transplant, most indicated openness to PC engagement for their patients.

They are my worries, so it's me the doctor should listen to-adolescent males' experiences of consultations with general practitioners

BACKGROUND

Many adolescent males visit a general practitioner regularly, yet many report unmet health needs and negative experiences. This indicates a gap between provided healthcare and the needs of adolescent males. In order to improve adolescent males' possibilities to discuss their health concerns with general practitioners, the study's aim was to explore and describe how adolescent males understand and assign meaning to their experiences of consultations with general practitioners.

METHODS

This qualitative study was conducted at two healthcare centres in mid-Sweden in 2022. Nine males 15 to 19 years old described their experiences in semi-structured interviews immediately after consulting a general practitioner, regardless of reason for the consultation and whether or not accompanied by a parent. The analysis was guided by thematic analysis according to Braun & Clarke and reflective lifeworld theory's concepts of openness and sensitivity.

RESULTS

One overarching theme, To be listened to, and three themes were developed: To handle insecurity and uneasiness, To be understood and cared for, and To get parental support on his terms. In a good appointment, the general practitioner cares about him, listens attentively, and takes him seriously. More importantly, the general practitioner's understanding permeates the consultation, so that all aspects of it is adapted to him. The adolescent males doubted their ability to express themselves and to understand what would happen in the consultation, and therefore feared being dismissed without receiving any help. Such difficulties may be due to unfinished neurocognitive development and inexperience. They struggled with embarrassment, partly due to notions of masculinity, and strived to balance their needs of parental support, privacy, and being the one that the doctor listens to.

CONCLUSIONS

We argue that adolescent males are particularly vulnerable due to on-going neurocognitive and emotional development, inexperience, and notions of masculinity. However, good experiences can be generated through rather simple means. Adolescent males need individual adaptations demonstrating that they are cared for, understood and taken seriously. Furthermore, they need an unhurried pace to facilitate understanding, verbal affirmations to mitigate embarrassment, and help in navigating parental involvement.

Enabling flourishing: novel approaches in palliative medicine for children with advanced kidney disease

PURPOSE OF REVIEW

Paediatric kidney disease results in considerable burden on children and their families. Paediatric palliative care is a holistic, family-centred care approach intended to enable flourishing and address the many impediments to life participation which advanced kidney disease can impose. To date, palliative care resources have been underutilized in paediatric nephrology. This review will highlight recent literature targeting the engagement and life participation of children with advanced kidney disease through implementation of novel palliative care approaches and propose directions for future research.

RECENT FINDINGS

Children with advanced kidney disease and their families highly value incorporation of their perspectives, particularly on life participation, within care plan development; but what it means to participate in life can be variable, and clinicians need improved tools to ascertain and incorporate these perspectives. Novel palliative care interventions developed for application in comparable disease states offer potential opportunities for paediatric nephrologists to support this goal.

SUMMARY

Children with advanced kidney disease and their families will benefit from incorporation of their perspectives and values, facilitated by palliative interventions.

Caregiver perspectives of dialysis initiation for children with kidney disease: a qualitative study

BACKGROUND

To better support family-centered care surrounding dialysis initiation, greater understanding of caregiver experience is necessary.

METHODS

Using thematic analysis, we conducted a secondary analysis of semi-structured interview data from a qualitative study of caregivers of children receiving dialysis recruited from 3 pediatric centers. Prominent themes in caregiver experience of caring for a child initiating dialysis were identified.

RESULTS

Thirty-five caregivers participated. Three major themes emerged from qualitative analysis: (1) parenting disrupted - caregivers experienced an acute disruption in their parenting role due to the unexpected, emergent circumstances and vast information accompanying their child's diagnosis; (2) redefining parenting - caregivers sought to reestablish their innate parental role and foster their evolving medical provider role through reassurance that their child could survive, communication with the medical team, and engaging in care plan development; and (3) leveraging dual identities - to positively impact their child's experience and enable flourishing, caregivers leveraged their established caregiver role and newly realized medical provider role through voicing their perspectives, watching over their child's care, and preparing for future changes in their child's health. If caregivers' evolution was not nurtured and enabled, acute fluctuations in their child's care could contribute to future disruption and need to restore their parental role. However, if caregiver development was fostered, caregivers acquired increased ability to prepare for vacillations in their child's care.

CONCLUSIONS

Improving delivery of family-centered care and support of caregivers at dialysis initiation will require directed efforts by nephrology care teams to foster caregiver evolution and resilience and respond to the family's changing experience of kidney disease. A higher resolution version of the Graphical abstract is available as Supplementary information.

Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers

Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.

Adding Life to Their Years: The Current State of Pediatric Palliative Care in CKD

Despite continued advances in medical treatment, pediatric CKD remains an unremitting, burdensome condition characterized by decreased quality of life and earlier death. These burdens underscore the need for integration of pediatric palliative care (PPC) into nephrology practice. PPC is an evolving field that strives to (1) relieve physical, psychologic, social, practical, and existential suffering; (2) improve quality of life; (3) facilitate decision making; and (4) assist with care coordination in children with life-threatening or life-shortening conditions. Integration of palliative care into routine care has already begun for adults with kidney disease and children with other chronic diseases; however, similar integration has not occurred in pediatric nephrology. This review serves to provide a comprehensive definition of PPC, highlight the unmet need in pediatric nephrology and current integration efforts, discuss the state of palliative care in adult nephrology and analogous chronic pediatric disease states, and introduce future opportunities for study.

Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence

OBJECTIVE

To evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence.

METHODS

AYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence.

RESULTS

AYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider.

CONCLUSIONS

Post-visit adherence was higher when AYAs were rated as more engaged and providers as less negative.

PRACTICE IMPLICATIONS

AYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.