Current understanding of patient-physician communication is based on cross-sectional observations of visit dialogue. While providing important insights into variation in physicians' communication style, cross sectional data cannot answer questions regarding the cumulative effect of on-going relationships on doctor-patient communication. Consequently, longitudinality is little understood. There have been virtually no studies of doctor-patient communication over time. Nevertheless, longitudinality has long been considered a critical element of quality of care. An often assumed benefit of longitudinality is an enhancement of communication and the building of patient trust and comfort, particularly in regard to disclosure of sensitive psychosocial information. The goal of this study is to describe the communication dynamics of longitudinal pediatric care in regard to maternal emotional distress during the first postpartum year. We will investigate the effect of longitudinality and pediatricians' communication style on: 1) specific elicitation of maternal distress; 2) spontaneous and elicited maternal disclosure of distress; 3) pediatricians accurate detection of maternal distress; 4) pediatrician responsiveness to maternal disclosure of distress; and, 5) maternal responsiveness to pediatricians' recommendation regarding distress. Design: Longitudinal observational study (using audiotapes) of interactions between mothers and pediatricians during well child care in the first postpartum year. Subjects: a) pediatric residents (approximately 65) in their first and second years of training; b) mothers (approximately 260) bringing their newborn children for longitudinal, comprehensive care to the primary care pediatric clinic of an inner city teaching hospital. Total number of visits observed approximately 1100. Dependent variables: maternal disclosure of distress and psychosocial risk factors, specific physician probes used to elicit disclosures, physicians' correct identification of mothers' distress, physician responses to disclosures (all coded from audiotapes, parent, or physician questionnaires). Independent variables: physician interview style coded using the Roter Interactional Analysis System, maternal distress measured by GHQ-28, family violence measured by Conflict Tactics Scale. Signficance: The study will develop new information in 4 areas: 1) importance of longitudinal care in the elicitation and treatment of mental disorders in primary care; 2) development of specific probes for eliciting maternal distress; 3) development of a knowledge base for design of trials of communication-skills interventions with physicians caring for children and their mothers; 4) extension of communication training to include responses to disclosure of distress.
| Wissow, Lawrence S; Larson, Susan; Anderson, Jada et al. (2005) Pediatric residents' responses that discourage discussion of psychosocial problems in primary care. Pediatrics 115:1569-78 |
| Wissow, Lawrence S; Larson, Susan M; Roter, Debra et al. (2003) Longitudinal care improves disclosure of psychosocial information. Arch Pediatr Adolesc Med 157:419-24 |
| Wissow, Lawrence S; Roter, Debra; Larson, Susan M et al. (2002) Mechanisms behind the failure of residents' longitudinal primary care to promote disclosure and discussion of psychosocial issues. Arch Pediatr Adolesc Med 156:685-92 |
