School of Public Health, Purdue University, West Lafayette, Indiana, USA.
Howard University, Washington, District of Columbia, USA.
Pediatr Blood Cancer. 2024 Oct;71(10):e31227. doi: 10.1002/pbc.31227. Epub 2024 Jul 25.
Effective communication is founded on bidirectional participation from families and healthcare providers. In adult medicine, bidirectional communication promotes treatment adherence and builds the family-provider relationship. However, the relationship between communication styles in pediatrics remains poorly understood, particularly in culturally diverse settings. This study aims to investigate parent-provider communication dynamics and parental involvement during diagnostic cancer communication in Guatemala.
This qualitative study included 20 families of children with cancer and 10 providers at Unidad Nacional de Oncología Pediátrica in Guatemala. Psychoeducation and diagnostic conversations between parents, psychologists, and oncologists were recorded and thematically analyzed using a priori and novel codes exploring communication behaviors, parental engagement, and interpersonal dynamics.
Participating parents had children with various diagnoses. Only 15% of fathers and 5% of mothers reported education beyond primary school. Providers spoke 68% of words during psychoeducation and 85% of words during diagnosis conversations. Providers used supportive communication behaviors providing explanations, demonstrating verbal attentiveness, and soliciting questions and non-supportive behaviors including paternalistic talk. Parental participation was considered active when they asked questions, expressed hopes or concerns, or asserted their opinions, and non-active when participation was limited to brief responses to closed-ended questions. Supportive provider communication often encouraged active participation; non-supportive communication did not. Furthermore, active parental participation prompted supportive communication from providers, while non-active participation did not.
Our findings highlight the bidirectional nature of effective communication, establishing that provider communication styles both influence and are influenced by parental participation, and emphasizing the importance of supportive provider communication for patient-centered care.
有效的沟通建立在医患双方的双向参与之上。在成人医学中，双向沟通可促进治疗依从性并建立医患关系。然而，儿科沟通方式之间的关系仍知之甚少，尤其是在文化多样化的环境中。本研究旨在探讨危地马拉儿科癌症诊断沟通中家长与提供者之间的沟通动态和家长参与度。
这项定性研究包括危地马拉国立儿科肿瘤学的 20 个癌症患儿家庭和 10 名提供者。对父母、心理学家和肿瘤学家之间的心理教育和诊断对话进行了录音，并使用探索沟通行为、家长参与度和人际动态的预设和新代码进行了主题分析。
参与的父母的孩子患有各种不同的疾病。只有 15%的父亲和 5%的母亲接受过小学以上的教育。在心理教育过程中，提供者讲话占 68%，在诊断对话中占 85%。提供者使用了支持性的沟通行为，包括提供解释、表现出言语关注、征求问题以及非支持性行为，包括家长式的谈话。当父母提问、表达希望或担忧或坚持自己的意见时，他们的参与被认为是积极的，而当他们的参与仅限于对封闭式问题的简短回答时，则被认为是非积极的。支持性的提供者沟通往往鼓励积极参与；非支持性的沟通则没有。此外，积极的家长参与会促使提供者提供支持性的沟通，而消极的家长参与则不会。
我们的研究结果强调了有效沟通的双向性，确定了提供者的沟通方式既影响又受到家长参与的影响，并强调了支持性提供者沟通对于以患者为中心的护理的重要性。
