Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia; Faculty of Social Sciences, Radboud University Nijmegen, Netherlands.
J Adolesc Health. 2014 Jul;55(1):59-64. doi: 10.1016/j.jadohealth.2013.11.024. Epub 2014 Feb 8.
Current guidance about adolescent-friendly health care emphasizes the benefits of seeing young people alone for confidential consultations. Yet in young people with Type 1 diabetes mellitus (T1DM), parental involvement has been shown to contribute to better diabetes control. This study aimed to better understand how these apparent tensions are reconciled in clinical practice by identifying how frequently adolescents with T1DM are seen alone and exploring parents' opinions about this.
A convenience sample of consecutive parents of adolescents (aged 12-21 years) with T1DM was recruited from the outpatient clinic of a specialist diabetes service and asked to complete a 30-item written survey.
A total of 137 surveys were returned from 146 eligible parents (94%) of whom 106 had complete data. Thirteen percent of adolescents with T1DM had ever been seen alone for a confidential consultation with their doctor. The most common concern for parents about confidential care was not being informed about important information, not just about T1DM, but also about common adolescent risk behaviors and mental health states.
These findings suggest that young people with T1DM are not being routinely seen alone for confidential care. This could be attributed to: parents or adolescents declining confidential care; clinicians being time-poor and/or lacking the necessary skills; or a culture of uncertainty about the value of confidential care. A discussion is now required about how best to enact adolescent-friendly care in the chronic-illness outpatient setting, where parental involvement is understood to be important for effective chronic illness management.
目前关于青少年友好型医疗保健的指南强调了为年轻人提供单独进行保密咨询的好处。然而，在 1 型糖尿病（T1DM）的年轻人中，已经证明父母的参与有助于更好地控制糖尿病。本研究旨在通过确定 T1DM 青少年单独就诊的频率，并探讨父母对此的看法，更好地了解如何在临床实践中调和这些明显的紧张关系。
从一家专科糖尿病服务的门诊科室中，便利地招募了 12-21 岁 T1DM 青少年的连续父母作为研究对象，并要求他们填写一份 30 项的书面调查问卷。
共有 146 名符合条件的父母中的 137 名（94%）返回了调查问卷，其中 106 名父母提供了完整的数据。13%的 T1DM 青少年曾单独与医生进行过保密咨询。父母对保密护理最常见的担忧是没有被告知重要信息，不仅是关于 T1DM 的信息，还有关于青少年常见风险行为和心理健康状况的信息。
这些发现表明，T1DM 青少年并未常规地单独接受保密护理。这可能归因于：父母或青少年拒绝保密护理；临床医生时间紧张和/或缺乏必要的技能；或者对保密护理的价值存在不确定性的文化。现在需要讨论如何在慢性病门诊环境中最好地实施青少年友好型护理，因为在这种环境中，父母的参与被认为对有效的慢性病管理很重要。
