Simms MaryJane, Baumann Katherine, Monaghan Maureen
Children's National Health System, Washington, DC.
George Washington University School of Medicine, Washington, DC.
Clin Pract Pediatr Psychol. 2017 Dec;5(4):415-425. doi: 10.1037/cpp0000211.
In an effort to refine a model of clinical care identifying effective communication with health care providers (HCPs) as a key skill for successful transition to adult medical care, this study explored the perspectives of emerging adults with type 1 diabetes (T1D) about factors that impact the quality and content of communication with their HCPs.
Twenty emerging adults with T1D were interviewed about health communication experiences with their pediatric HCP and readiness for transition to adult diabetes care. Interviews were recorded and transcribed; three raters coded transcripts using conventional content analysis for broad themes.
Five themes emerged from the data capturing factors that influence emerging adult-HCP communication: HCP interaction style, HCP consistency, HCP support for autonomy, parental involvement in medical care, and emerging adult comfort with disclosure. Most emerging adults had not discussed transition to adult diabetes care with their HCP; some expressed confidence in their ability to transition while others expressed anxiety about the transition process.
Findings support the conceptual model of communication and inform clinical implications for working with emerging adults with T1D. Continuity of care should be prioritized with transition-age patients. Additionally, HCPs should initiate conversations about engagement in risky behaviors and transition to adult medical care and ensure emerging adults have time without parents to discuss these sensitive topics. Psychologists can enhance the transition process by facilitating effective patient-HCP communication and coaching both patients and HCPs to ask questions about risky behaviors and transition to adult medical care.
为完善临床护理模式，该模式将与医疗服务提供者（HCPs）进行有效沟通视为成功过渡到成人医疗护理的关键技能，本研究探讨了1型糖尿病（T1D）青少年对影响其与HCPs沟通质量和内容的因素的看法。
对20名患有T1D的青少年进行了访谈，了解他们与儿科HCP的健康沟通经历以及向成人糖尿病护理过渡的准备情况。访谈进行了录音和转录；三名评分者使用传统内容分析法对转录本进行编码，以确定广泛的主题。
数据中出现了五个主题，涵盖影响青少年与HCP沟通的因素：HCP的互动风格、HCP的一致性、HCP对自主性的支持、父母对医疗护理的参与以及青少年对披露信息的舒适度。大多数青少年尚未与他们的HCP讨论过向成人糖尿病护理的过渡；一些人对自己过渡的能力表示有信心，而另一些人则对过渡过程表示焦虑。
研究结果支持沟通的概念模型，并为与患有T1D的青少年合作提供了临床启示。对于处于过渡年龄的患者，应优先考虑护理的连续性。此外，HCPs应主动开展关于危险行为参与和向成人医疗护理过渡的对话，并确保青少年有时间在没有父母在场的情况下讨论这些敏感话题。心理学家可以通过促进有效的患者与HCP沟通，并指导患者和HCP就危险行为和向成人医疗护理过渡提出问题，来加强过渡过程。
