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Patient-Centered Communication and Health Assessment With Youth

Martyn, Kristy K.; Munro, Michelle L.; Darling-Fisher, Cynthia S.; Ronis, David L.; Villarruel, Antonia M.; Pardee, Michelle; Faleer, Hannah E.; Fava, Nicole M.

doi: 10.1097/NNR.0000000000000005
FEATURE ARTICLES
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Background: Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth.

Objectives: The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained.

Methods: This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest).

Results: Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction.

Discussion: EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Kristy K. Martyn, PhD, RN, CPNP-PC, FNP-BC, is Acting Professor and Assistant Dean of Clinical Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.

Michelle L. Munro, MS, RN, CNM, FNP-BC, is Research Fellow, Cynthia S. Darling-Fisher, PhD, RN, FNP-BC, is Clinical Assistant Professor; David L. Ronis, PhD, is Research Scientist; Antonia M. Villarruel, PhD, RN, FAAN, is Professor, Nola J. Pender Collegiate Chair; and Michelle Pardee, DNP, RN, FNP-BC, is Clinical Assistant Professor, School of Nursing, University of Michigan, Ann Arbor.

Hannah E. Faleer, BS, is Doctoral Student, Department of Psychology, Northern Illinois University, DeKalb.

Nicole M. Fava, PhD, MSW, is Postdoctoral Fellow, Wayne State University, Detroit, MI.

Accepted for publication August 8, 2013.

The authors gratefully acknowledge support by the National Institutes of Health, National Institute of Mental Health, R34-MH-082644 (PI: Kristy K. Martyn). Support to Michelle Munro was provided by the National Institutes of Health, National Institute of Nursing Research Grant Number F31NR012852. The authors also acknowledge the Access Community Health and Research Center, Washtenaw County Public Health Department, and Eastern Michigan University–University Health Services for their assistance with recruitment and data collection. Findings from this research were reported at the Conference on Pediatric Health Care, National Association of Pediatric Nurse Practitioners, April 2013, Orlando, FL.

The authors have no conflicts of interest to disclose.

Corresponding author: Kristy K. Martyn, PhD, RN, CPNP-PC, FNP-BC, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Rm. 346, Atlanta, GA 30322 (e-mail:kmartyn@emory.edu).

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.