Sices Laura, Drotar Dennis, Keilman Ashley, Kirchner H Lester, Roberts David, Stancin Terry
Department of Pediatrics, Division of Child Development, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Pediatrics. 2008 Nov;122(5):e1091-9. doi: 10.1542/peds.2008-1773.
The American Academy of Pediatrics recommends periodic administration of standardized developmental screening instruments during well-child visits to facilitate timely identification of developmental delay. However, little is known about how parents and physicians communicate about child development or how screening impacts communication.
Our goal was to examine whether parent-physician communication about child development is affected by (1) administration of a developmental screen or (2) video presentation on child development before well-child visits.
Six primary care pediatricians in a practice serving predominantly Medicaid-insured children participated. Fifteen parents of children 9 to 31 months of age per pediatrician were assigned to 1 of 3 previsit conditions (n = 89): (1) usual care; (2) parent completed the Parents' Evaluation of Developmental Status screen; or (3) parent viewed 5-minute "activation" video before completing the Parents' Evaluation of Developmental Status. Visits were audiorecorded and coded by blinded raters using a classification system that assesses communication content. Outcomes included visit length, physicians' questions, information giving, reassurance or counseling about development, and parents' concerns and requests for developmentally related services.
Mean visit duration was similar for the 3 groups (22.5 minutes). Physicians made more information-giving and counseling statements about development and raised more developmental concerns in group 3 (video plus the Parents' Evaluation of Developmental Status) than in group 1 (usual care) visits. A trend toward increased use of such communication was also seen in group 2 (Parents' Evaluation of Developmental Status only). Parents were more likely to raise a developmental concern in group 3 than in group 1. No parent requested early intervention, therapy, or other related services.
Use of a validated screening test did not increase average visit duration, an important consideration in primary care. Although use of the Parents' Evaluation of Developmental Status alone led to some increase in parent-physician communication about development and developmental concerns, additional increase in communication was seen with the addition of a brief parent activation video shown before the Parents' Evaluation of Developmental Status was completed.
美国儿科学会建议在儿童健康检查期间定期使用标准化发育筛查工具，以便及时发现发育迟缓情况。然而，对于父母与医生如何就儿童发育情况进行沟通，以及筛查如何影响沟通，我们知之甚少。
我们的目标是研究父母与医生关于儿童发育的沟通是否受到以下因素的影响：（1）进行发育筛查；（2）在儿童健康检查前播放关于儿童发育的视频。
六位主要为医疗补助保险儿童提供服务的基层医疗儿科医生参与了研究。每位儿科医生将15名9至31个月大儿童的家长分配到三种检查前情况中的一种（n = 89）：（1）常规护理；（2）家长完成《父母发育状况评估》筛查；（3）家长在完成《父母发育状况评估》之前观看5分钟的“激活”视频。访视过程进行了录音，由不知情的评分者使用评估沟通内容的分类系统进行编码。结果包括访视时长、医生的问题、信息提供、关于发育的安慰或咨询，以及家长的担忧和对发育相关服务的请求。
三组的平均访视时长相似（22.5分钟）。与第1组（常规护理）访视相比，第3组（视频加《父母发育状况评估》）的医生在发育方面提供了更多信息和咨询，并提出了更多发育方面的担忧。第2组（仅进行《父母发育状况评估》）在这类沟通的使用上也有增加的趋势。第3组的家长比第1组的家长更有可能提出发育方面的担忧。没有家长要求早期干预、治疗或其他相关服务。
使用经过验证的筛查测试并没有增加平均访视时长，这在基层医疗中是一个重要的考虑因素。虽然仅使用《父母发育状况评估》会使父母与医生关于发育和发育问题的沟通有所增加，但在完成《父母发育状况评估》之前播放一段简短的家长激活视频后，沟通进一步增加。
